A systematic review of fasciotomy in chronic exertional compartment syndrome

Ding, Anni; Machin, Matthew; Onida, Sarah; Davies, Alun H.

doi:10.1016/j.jvs.2020.05.030

Cited by 23 publications

(27 citation statements)

References 34 publications

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“…Given that a patient may injure another area of their body within that time frame, only the lower-limb portion of the deployability status was considered. One year has been recommended as the optimal follow-up time given that it allows sufficient time to recover from surgery, as well as enabling the identification of re-occurrences 47 , 48 . Deployability status was assessed by a local medical officer or the occupational medical board and judged against the UK Joint Service Medical Deployment Standards (JSP-950).…”

Section: Methodsmentioning

confidence: 99%

Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies

Houston

Cosma

Turner³

et al. 2021

Sci Rep

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Chronic exertional compartment syndrome (CECS) is a condition occurring most frequently in the lower limbs and often requires corrective surgery to alleviate symptoms. Amongst military personnel, the success rates of this surgery can be as low as 20%, presenting a challenge in determining whether surgery is worthwhile. In this study, the data of 132 fasciotomies for CECS was analysed and using combinatorial feature selection methods, coupled with input from clinicians, identified a set of key clinical features contributing to the occupational outcomes of surgery. Features were utilised to develop a machine learning model for predicting return-to-work outcomes 12-months post-surgery. An AUC of 0.85 ± 0.08 was achieved using a linear-SVM, trained using 6 features (height, mean arterial pressure, pre-surgical score on the exercise-induced leg pain questionnaire, time from initial presentation to surgery, and whether a patient had received a prior surgery for CECS). To facilitate trust and transparency, interrogation strategies were used to identify reasons why certain patients were misclassified, using instance hardness measures. Model interrogation revealed that patient difficulty was associated with an overlap in the clinical characteristics of surgical outcomes, which was best handled by XGBoost and SVM-based models. The methodology was compiled into a machine learning framework, termed AITIA, which can be applied to other clinical problems. AITIA extends the typical machine learning pipeline, integrating the proposed interrogation strategy, allowing to user to reason and decide whether to trust the developed model based on the sensibility of its decision-making.

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Section: Methodsmentioning

confidence: 99%

Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies

Houston

Cosma

Turner³

et al. 2021

Sci Rep

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show abstract

“…A dynamic intra-compartmental pressure (ICP) measurement using the Pedowitz cut-off criteria (8) serves as a gold standard diagnostic tool (4). CECS predominantly occurs in one or more of the four lower leg compartments (5,9). The anterior compartment is identified as the one most commonly affected (40-60%) (3,10) while superficial posterior compartment syndrome has been described as rare (11).…”

Section: Introductionmentioning

confidence: 99%

“…Techniques include an open fasciotomy, fasciotomy with partial fasciectomy or a minimally invasive (endoscopic) approach (12). However, the number of simultaneously released compartments (one to four) may vary (5,12) whereas the associated surgical outcome is inconsistent (5,9,12). A four-compartment fasciotomy (4-CF) implies opening all compartments of one lower leg within one surgical procedure (14) while a two-compartment release (2-CF) CECS: chronic exertional compartment syndrome, ICP: intra-compartmental pressure, 4-CF: four-compartment fasciotomy, 2-CF: two-compartment fasciotomy, SD: standard deviation, ES: effect sizes, OR: odds ratio, CI: confidence Interval, SMD: standardized mean difference, CASP: Critical Appraisal Skills Programme, GRADE: Grading of Recommendations Assessment, Development and Evaluation, EQ-5D: European Quality of Life -Five Dimensions questionnaire 6 indicates a fascia incision of two compartments, mostly -but not always -the anterior and lateral compartment (9).…”

Section: Introductionmentioning

confidence: 99%

“…However, the number of simultaneously released compartments (one to four) may vary (5,12) whereas the associated surgical outcome is inconsistent (5,9,12). A four-compartment fasciotomy (4-CF) implies opening all compartments of one lower leg within one surgical procedure (14) while a two-compartment release (2-CF) CECS: chronic exertional compartment syndrome, ICP: intra-compartmental pressure, 4-CF: four-compartment fasciotomy, 2-CF: two-compartment fasciotomy, SD: standard deviation, ES: effect sizes, OR: odds ratio, CI: confidence Interval, SMD: standardized mean difference, CASP: Critical Appraisal Skills Programme, GRADE: Grading of Recommendations Assessment, Development and Evaluation, EQ-5D: European Quality of Life -Five Dimensions questionnaire 6 indicates a fascia incision of two compartments, mostly -but not always -the anterior and lateral compartment (9). Although surgery may result in high rates of "return to activity" and "satisfaction" (48-94%) (5,9) compared to non-surgical methods (<50%) (5), outcome remains suboptimal.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Two-Compartment or 4-Compartment Fasciotomy for Lower Leg Chronic Exertional Compartment Syndrome: A Systematic Review

Weiss

Vogels

Wee

et al. 2022

The Journal of Foot and Ankle Surgery

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“…However, that is the case with this article evaluating fasciotomy vs conservative therapy for chronic exertional compartment syndrome. 1 One may ask, Why did the editors choose to publish this analysis? The answer is that chronic exertional compartment syndrome is increasingly being diagnosed and treated not only by orthopedic surgeons but also by vascular surgeons, many of whom may have limited experience with this condition.…”

mentioning

confidence: 99%

Fasciotomy for chronic exertional compartment syndrome remains controversial

Samson¹

2020

Journal of Vascular Surgery

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A systematic review of fasciotomy in chronic exertional compartment syndrome

Cited by 23 publications

References 34 publications

Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies

Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies

Two-Compartment or 4-Compartment Fasciotomy for Lower Leg Chronic Exertional Compartment Syndrome: A Systematic Review

Fasciotomy for chronic exertional compartment syndrome remains controversial

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