Surgical management of exertional compartment syndrome of the lower leg

Abstract

Forty-six limbs in 28 patients were surgically treated for exertional compartment syndrome. One group of 16 patients (26 limbs) underwent a fasciotomy for exertional anterior compartment syndrome (Group 1). A second group of 12 patients (20 limbs) underwent a fasciotomy for exertional deep posterior compartment syndrome (Group 2). Patients in Group 2 experienced symptoms for a significantly longer time than those in Group 1:16 versus 6.8 months (P < 0.01). All three of the pressure measurements used in this study (resting pressure, 1 minute after exercise, and 5 minutes after exercise) were significantly higher in both groups than in normal controls (P < 0.01). The 1 minute after exercise values were significantly higher in Group 1 (mean, 36.5) than in Group 2 (mean, 29.1) (P < 0.01). In Group 1, 25 of 26 limbs (96%) had excellent results. In Group 2, 13 of 20 limbs (65%) had satisfactory results (5 excellent and 8 good) and 7 (35%) had unsatisfactory results (4 fair and 3 poor). Those patients who had an unsatisfactory outcome did so within 6 months. Patients in Group 1 had a significantly higher rate of satisfactory results than those in Group 2 (P < 0.05).

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.…”

“…In fact, the reported success for anterior and lateral compartment decompression surgery varies between 65% and 100% [6-8, 11, 15, 17, 18, 20], while for the posterior compartment the percentage is between 50% and 75% [1,3,4,8,[17][18][19].…”

Anatomic survey of the common fibular nerve and its branching pattern with regard to the intermuscular septa of the leg

“…This might explain why acute or chronic compartment syndromes are caused by elevating intramuscular pressure to a point where ischemic pain occurs (Schepsis et al, 1993). The description of two separate origins of the fibularis longus muscle has only been mentioned by Parsons Schaeffer (1942), Reimann (1984), Bakkum et al (1996), and Dellon et al (2002).…”

“…6). An increase of intramuscular pressure during compartment syndrome is also caused by diminishing venous blood flow (Schepsis et al, 1993). In consequence, it can be hypothesized that venous dilatation compresses the crossing nerves, but has not yet been proved by clinical investigation.…”

Mini-Open Posterior Compartment Release for Chronic Exertional Compartment Syndrome of the Leg

“…3 Seven studies (131 patients) met the criteria and were included in this systematic review, all consisting of level 3 evidence. [6][7][8][9][10][11][12] Success rates in the analyzed studies ranged from only 30% to 65%.…”