Limits...
Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study.

Orlin JR, Øen J, Andersen JR - J Orthop Surg Res (2013)

Bottom Line: ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain.Leg pain improved from a score of 8.0±1.5 to 2.3±2.1, P<0.001.Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Intracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief.

Methods: A standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years.

Results: Follow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0±1.5 to 2.3±2.1, P<0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.

Conclusions: The diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.

Show MeSH

Related in: MedlinePlus

Photograph of patient’s leg after surgery. The three fasciotomy incisions used to access all compartments are illustrated. Continuous black lines indicate skin incisions, and dotted lines between arrows indicate the extent of the subcutaneous fascia splitting: approximately 20 cm in the anterior, lateral, and superficial posterior compartments and approximately 10 cm in the deep posterior compartment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3643830&req=5

Figure 1: Photograph of patient’s leg after surgery. The three fasciotomy incisions used to access all compartments are illustrated. Continuous black lines indicate skin incisions, and dotted lines between arrows indicate the extent of the subcutaneous fascia splitting: approximately 20 cm in the anterior, lateral, and superficial posterior compartments and approximately 10 cm in the deep posterior compartment.

Mentions: General anesthesia was used except in one case, in which spinal anesthesia was employed. As illustrated in Figure 1, fascia splitting was performed in all four compartments and in one leg at a time through three short skin incisions, an adaptation to modern endoscopic principles. Only the fascia of the anterior compartment was split blindly. The superficial fibular nerve was protected by splitting the fascia under direct vision. The other leg was operated on only after the patient indicated satisfaction with the results of the first operation. The distance between fascial edges was noted. Patients were encouraged to walk from day one and to use elastic stockings for 2 months as protection against phlebitis and deep venous thrombosis (DVT). Follow-ups were performed by someone other than the person who performed the surgery. The mean follow-up time was 2.8 years (range 2–4.3 years). Complications, including hematomas, infections, DVT, and any unintended loss of sensitivity, were registered.


Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study.

Orlin JR, Øen J, Andersen JR - J Orthop Surg Res (2013)

Photograph of patient’s leg after surgery. The three fasciotomy incisions used to access all compartments are illustrated. Continuous black lines indicate skin incisions, and dotted lines between arrows indicate the extent of the subcutaneous fascia splitting: approximately 20 cm in the anterior, lateral, and superficial posterior compartments and approximately 10 cm in the deep posterior compartment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643830&req=5

Figure 1: Photograph of patient’s leg after surgery. The three fasciotomy incisions used to access all compartments are illustrated. Continuous black lines indicate skin incisions, and dotted lines between arrows indicate the extent of the subcutaneous fascia splitting: approximately 20 cm in the anterior, lateral, and superficial posterior compartments and approximately 10 cm in the deep posterior compartment.
Mentions: General anesthesia was used except in one case, in which spinal anesthesia was employed. As illustrated in Figure 1, fascia splitting was performed in all four compartments and in one leg at a time through three short skin incisions, an adaptation to modern endoscopic principles. Only the fascia of the anterior compartment was split blindly. The superficial fibular nerve was protected by splitting the fascia under direct vision. The other leg was operated on only after the patient indicated satisfaction with the results of the first operation. The distance between fascial edges was noted. Patients were encouraged to walk from day one and to use elastic stockings for 2 months as protection against phlebitis and deep venous thrombosis (DVT). Follow-ups were performed by someone other than the person who performed the surgery. The mean follow-up time was 2.8 years (range 2–4.3 years). Complications, including hematomas, infections, DVT, and any unintended loss of sensitivity, were registered.

Bottom Line: ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain.Leg pain improved from a score of 8.0±1.5 to 2.3±2.1, P<0.001.Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Intracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief.

Methods: A standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years.

Results: Follow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0±1.5 to 2.3±2.1, P<0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL.

Conclusions: The diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.

Show MeSH
Related in: MedlinePlus