OTA 1998 Posters

Morbidity of Two Incision Fasciotomy for Compartment Syndromes of the Lower Extremity

Robert Harris, MD; Steve Huish, MD; Charlie Reinert, MD; Alan Jones, MD, US Army Institute of Surgical Research, San Antonio, TX; University of Texas, Southwestern School of Medicine, Department of Orthopaedic Surgery, Dallas, TX

Purpose (hypothesis): Open fasciotomy is advocated for established compartment syndromes of the lower extremity, with a reported minimal morbidity from this procedure. The purpose of this study was to determine the actual morbidity of open fasciotomies performed for lower extremity trauma.

Methods: From July 1990 to July 1995, patients who required open fascio-tomies for lower extremity trauma were included in a retrospective review to determine the morbidity of this surgical procedure. Chart reviews and patient interviews were conducted to evaluate the type of fracture, indication for fasciotomies, requirement for skin grafts, number of surgeries required to achieve soft tissue coverage, hospitalization time, delayed unions undergoing secondary procedures, and final functional outcomes.

Results: Twenty-two patients with 21 fractures underwent two incision open fasciotomies. There were 17 males and 5 females. There were six open fractures (Type I: 2, II: 2, IIIA: 1, B: 1). Fracture stabilization included 17 IM nails and 6 external fixators. Six patients (27%) had associated fractures and injuries. Clinical diagnosis was used to perform fasciotomies in ten patients (45%). In twelve patients, measured compartment pressures averaged 57mm Hg (45-95mm Hg) in the highest compartment. The average number of surgeries to achieve soft tissue coverage was 3. Eight patients (41%) required skin grafts, and one a free flap. Seven patients (32%) required additional surgery to achieve union. The average days of hospitalization was 15.8. Thirty percent of patients had residual minor neurologic or soft tissue defects.

Discussion: Most literature dealing with the surgical treatment of compartment syndromes stresses the need for emergent decompression but fails to look at the morbidity of this procedure. Our study demonstrates that this necessary procedure does carry a significant morbidity with its use, and patients need to be informed.