Chronic compartment syndrome: Diagnosis, management, and outcomes

Abstract

A consecutive operative series of 100 patients with chronic compartment syndrome involving 233 compartments is reported. Seven of every eight were athletes, and runners predominated. Exercise-induced symptoms of consistently recurring tightness, aching (in some, sharp pains) in anatomically defined compartments were pathognomonic. Mean months of symptoms prior to operation was 22; median age was 26 years. Bilaterality occurred in 82. The distribution of compartments was: anterior, 39%; lateral, 12%; and posterior, 48%. Incidental compartment pressures were elevated (mean = 23 mmHg). Fasciotomy using local anesthesia was performed on 70 outpatients. At a median of 4.5 months, over 90% were cured or significantly improved in symptoms and/or function. Median time to walking unassisted was 2 days, and to resumption of conditioned running 21 days. Fasciotomy can be a safe, effective, and economical treatment for chronic compartment syndrome.

Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg

“…Surgical fascial release is the mainstay of treatment of CECS of the leg [3,7,12,15,17,18], with report of improvement ranging from 65% to 100% [6-8, 11, 15, 17, 18, 20]. Our series with double incision fasciotomy show good results in 100% of patients with an anterior or antero-lateral leg CECS, at 2 years of follow up.…”

“…The specific method for performing fascia release is variable and various authors have used both a one [5,8,12] and two incisions [16,17,19,21] techniques; Detmer [7] have suggested three or more incisions for patients with excessively long legs. Recently, the use of endoscope has been proposed to assist visualisation of fasciotomy with single [10,13] or double incisions [11].…”

“…The problem is that, over time, this condition becomes more severe, and a raised intra-compartimental pressure may cause relative ischemia of the involved muscles [1,20]. Some authors [7,15] had suggested that activity induced muscle swelling is restricted by fascial tightness; this theory is used to propose fasciotomy as the treatment of choice for this condition [3, 5-7, 14, 17, 18, 22]. The most commonly affected compartments in the leg are the anterior followed by the deep posterior, lateral, and rarely the superficial posterior compartment [1,2,8].…”

“…Different techniques have been described for fasciotomy and fasciectomy of the leg, such as open one [5,6,8,12], or two incisions fasciotomy [2,17,19], endoscopically assisted one [10,13] or two [11] incisions fasciotomy, and fasciectomy [3,4]. The use of fasciotomy or fasciectomy has been debated, with some authors performing fasciotomy with a partial fasciectomy [19] and others [3,7] advocates fasciectomy only for recurrent cases when a previous compartment fasciotomy had failed. In this paper we describe the open minimal…”

Lumbar paraspinal compartment syndrome

“…The posterior layer of the fascia has been reported to stiffen (resist deformation) with successive loading [24]. In the leg, fascial thickening is associated with chronic compartment syndrome in response to loading [25,26]. According to Farfan et al [27], adaptive fascial thickening has been noted in the posterior layer based on comparative anatomical observations with other anthropoids.…”