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Archives of Orthopaedic and Trauma Surgery

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01-12-2019 | Lower Leg Fracture | Trauma Surgery

Selective fasciotomy for acute traumatic lower leg compartment syndrome: is it feasible?

Authors: B. A. Hatz, H. Frima, C. Sommer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2019

Abstract

Introduction

The standard treatment for an acute compartment syndrome (ACS) of the lower leg is a four compartment fasciotomy. It can be performed through either one lateral or a lateral and medial incision. Selective fasciotomy, only opening the compartments with elevated pressure, is a less invasive procedure. The aim of this study was to describe a procedure of selective fasciotomy after pressure measurement and to determine its feasibility in a retrospective cohort study.

Methods

All patients with an ACS of the lower leg due to a proximal or tibia shaft fracture (AO 41 or 42) who received either a four compartment fasciotomy or a selective fasciotomy after pressure measurement between 2006 and 2016 were included. Every compartment with an intracompartment pressure of more than 30 mmHg was opened. The primary outcome was any missed compartment syndrome after selective fasciotomy. Secondary outcomes were reoperations for completing four compartment fasciotomy and persistent sensomotoric deficits.

Results

Fifty-one patients with a mean age of 43 years (6–76) were included. Of these, 41 (80%) had a selective fasciotomy. There was no missed compartment syndrome. One patient had a reoperation 8 h after primary selective fasciotomy due to ACS of the superficial and deep flexor compartment. The anterior compartment had to be released in all patients. In 67%, the release of 2 compartments was sufficient. Six patients had postoperative sensomotoric deficits at discharge with full recovery during follow-up.

Conclusion

Selective fasciotomy is feasible and seems to be safe. Future comparative studies will have to focus on possible benefits of this less invasive treatment.

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Title: Selective fasciotomy for acute traumatic lower leg compartment syndrome: is it feasible?
Authors: B. A. Hatz
H. Frima
C. Sommer
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Lower Leg Fracture
Compartment Syndrome
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03260-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Selective fasciotomy for acute traumatic lower leg compartment syndrome: is it feasible?

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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