Crush Injuries of the Foot with Compartment Syndrome: Immediate One-Stage Management

Abstract

Severe crush injuries with compartment syndrome were treated in five patients by an immediate one-stage procedure. This procedure included the assessment of skin flap viability with accurate debridement of devascularized tissues. It was performed according to the split-thickness skin excision technique. Compartment pressures were measured and the fasciotomies were performed through open wounds or separate medial and lateral incisions. The medial incision was extended to release the tarsal tunnel. Fractures were reduced and internally fixed and exposed bones were covered with locally transposed muscles. Skin grafts, taken earlier for the skin viability assessment, were meshed and applied to replace skin loss. All wounds and fractures healed uneventfully with no major functional loss. In multiple trauma, the physician should maintain a high index of suspicion for early diagnosis and treatment of severe foot injuries. Early treatment leads to more desirable results, shorter hospitalization, and faster rehabilitation.

Review: Acute Compartment Syndrome of the Foot

“…21,37,41,4 The etiology of compartment syndrome includes any event that decreases compartment volume or increases content of a relatively fixed volume. 6,41 Typically, an inciting event results in hemorrhage, edema, or a combination thereof within a compartment. 4,7,9,11,14,17,22,23,28 Such events include crush injury, fracture, reperfusion injury, surgical procedures, or occlusive dressings.…”

Effectiveness of foot fasciotomies in foot and ankle trauma

“…In multiple previous case series, foot fasciotomies have been done in patients with compartment syndrome and proposed as the optimal treatment to decrease the risk of development of claw toes, neuropathic pain and neurological deficits 4 5 7 8. The two largest case series on foot fasciotomy outcomes previously are retrospective case series of 14 and 12 cases of foot compartment syndrome, respectively 4 7.…”

“…Currently, the best available guidance on the treatment of foot compartment syndrome is level 4 evidence, with the largest reported case series including only 14 patients 4 5 7 8. The purpose of this case–control study was to determine if foot fasciotomies correlated with improved outcomes in patients with severe, combat-related foot injuries.…”

Midterm Functional Outcome after Operative Management of Midfoot Injuries.

“…Midfoot fractures are fre quently not diagnosed during primary examination especially when associated with other injuries [6,7]. As a result of inadequate treatment, the complication rate is high [8] .Only recognized isolated fractures of the midfoot have an outcome with minimal functional impairment. The fracture dislocation of the Lis franc joint is the most frequent severe injury of the midfoot, but is still uncommon with incidence of 0.02% to 0.09% of all fractures.…”