Session II - Tibia
Fri., 10/8/04 Tibia, Paper #7, 10:36 am
Late Functional Outcome following Fasciotomy for Acute Compartment Syndrome of the Lower Leg
Purpose: Acute compartment syndrome of the lower leg is a condition that requires immediate surgical decompression. Failure to reach the diagnosis or delay may lead to irreparable damage to muscle and nerve, leading to poor long-term function. Although the cause, pathophysiology, and treatment of acute compartment syndrome have been well-described in the literature, there is limited knowledge of long-term course, as well as recovery of muscle strength and impact on health-related quality of life after surgical decompression.
Methods: We retrospectively reviewed records of a consecutive series of patients who were treated with surgical decompression of an acute compartment syndrome after an isolated trauma of the lower leg. All patients had undergone early fasciotomy within 6 hours of injury. They had a minimal follow-up of 2 years. In order to assess long-term outcome, we analyzed pain (visual analog scale) and range of motion and performed a neurologic examination of the lower limb. Subjects were asked to complete a standardized measure of health-related quality of life (SF-36). We also examined the recovery of muscle strength of the lower limb with use of a Biodex III dynamometer. Bilateral isokinetic (60°/sec and 120°/sec) strength of dorsiflexor, plantar flexor, invertor, and everter muscles of the ankle were tested. The results were compared with the other side and with a standardized control group of 10 healthy subjects, taking account of handedness (Azemar score).
Results: Fifteen men were reviewed at an average follow-up of 8 years (range, 2 to 13). The average age was 35 years (range, 25 to 50). The mechanism of injury was motor vehicle accident, 7; fall from own height, 3; and a direct blow, 5. Acute compartment syndrome was associated with fracture of the leg, 11; ankle fracture, 2; and soft tissue injuries only, 2. All four compartments of the leg were involved in 13 of 15 patients. All fractures were healed at the control. The SF-36 of 7 of the 15 patients showed limitation of activities of daily living. Diffuse pain of the leg during activities and swelling were the most symptomatic complaints. Deficits in sports activities were reported by 10 of 15 patients; 7 of those could not even run. Mobility of the knee joint was not affected. Even though we found dorsiflexion deficits in five patients, none of the patients had equinus contracture. More than half of the patients (8 of 15) showed a significant loss of strength (30%) of the ankle flexor, everter ,and invertor muscles, compared with the contralateral side and the control group.
Conclusion: Although this study was retrospective, it is one of the rare ones that investigated function and isokinetic strength in a group of patients after early decompression of a compartment syndrome of the leg. We were surprised to find out that half of the victims had a significant impairment in sports and even in activities of daily living. The impact on health-related quality of life was mainly due to pain, reduction of dorsiflexion, and reduction of muscle strength of the leg.
Significance: Although urgent decompression is of utmost importance in order to avoid severe long-term disabilities after acute compartment syndrome, it does not guarantee excellent functional end results. After adequate fracture and soft tissue healing, greater emphasis should be placed on lower extremity functional recovery, including a specific rehabilitation program of muscle strengthening.