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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.

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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.

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Pre- and postoperative VAS pain scores in both legs (N = 69).
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Figure 2: Pre- and postoperative VAS pain scores in both legs (N = 69).

Mentions: The VAS pain score improved from 8.0 ± 1.5 to 2.3 ± 2.1 (P < 0.001) (Figure 2). No significant correlations were found between the ICP score and the VAS pain score before surgery (Spearman’s rank test = −0.09, P = 0.622). When asked about satisfaction with the overall treatment result, 19 patients were very satisfied, 11 were satisfied, seven were uncertain, and none were dissatisfied. Prior to surgery, the SF-8 scores were much lower than those in the general population, indicating severe impairment. After surgery, the patients’ scores improved significantly and were in the normal range (Table 3). A higher VAS pain score after surgery (Spearman’s rank test = −0.81, P < 0.001) was significantly correlated with lower satisfaction with treatment. No significant correlations were found between treatment satisfaction and ICP before surgery (Spearman’s rank test = 0.09, P = 0.602), or between any of the variables listed in Table 2 (data not shown). The seven patients who were uncertain about satisfaction with the overall treatment result had more pain (as measured by VAS and SF-8) after surgery than the other patients (Mann–Whitney U-test, P < 0.05), but their preoperative pressures were not significantly different from the other patients (Mann–Whitney U-test, P > 0.05). We also observed that pain relief was achieved by decompression in compartments in which elevated pressure was not found.


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)

Pre- and postoperative VAS pain scores in both legs (N = 69).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Pre- and postoperative VAS pain scores in both legs (N = 69).
Mentions: The VAS pain score improved from 8.0 ± 1.5 to 2.3 ± 2.1 (P < 0.001) (Figure 2). No significant correlations were found between the ICP score and the VAS pain score before surgery (Spearman’s rank test = −0.09, P = 0.622). When asked about satisfaction with the overall treatment result, 19 patients were very satisfied, 11 were satisfied, seven were uncertain, and none were dissatisfied. Prior to surgery, the SF-8 scores were much lower than those in the general population, indicating severe impairment. After surgery, the patients’ scores improved significantly and were in the normal range (Table 3). A higher VAS pain score after surgery (Spearman’s rank test = −0.81, P < 0.001) was significantly correlated with lower satisfaction with treatment. No significant correlations were found between treatment satisfaction and ICP before surgery (Spearman’s rank test = 0.09, P = 0.602), or between any of the variables listed in Table 2 (data not shown). The seven patients who were uncertain about satisfaction with the overall treatment result had more pain (as measured by VAS and SF-8) after surgery than the other patients (Mann–Whitney U-test, P < 0.05), but their preoperative pressures were not significantly different from the other patients (Mann–Whitney U-test, P > 0.05). We also observed that pain relief was achieved by decompression in compartments in which elevated pressure was not found.

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