Published online May 18, 2017. doi: 10.5312/wjo.v8.i5.385
Peer-review started: November 29, 2016
First decision: February 17, 2017
Revised: March 4, 2017
Accepted: March 23, 2017
Article in press: March 24, 2017
Published online: May 18, 2017
To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome (ACS) and to correlate it with functional outcome.
Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale (LEFS)] and complications were assessed.
Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk (10 to 54 wk) and 23.8 ± 9.2 wk (12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness (76%) that caused difficulty in walking, running and squatting. Of 21 patients who had paralysis at diagnosis, 13 (62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients (48.3%) with severe disability, 10 patients (34.5%) with moderate disability and 5 patients (17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmHg respectively (P < 0.001).
ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intra-compartmental pressure (ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.
Core tip: Anterior and deep posterior compartments are commonly involved in acute compartment syndrome (ACS) of leg after tibial fracture. Assessment of functional outcome in these patients and correlation with deep posterior compartment pressure has never been reported. This study revealed that ACS in tibial fractures causes severe functional disability and about 48% patients were severely disabled at one year. But this study did not find statistically significant relation between fracture union rate and deep compartment pressure value. The intra-compartmental pressure correlates with functional disability. Patients with relatively high pressure are prone for severe residual pain and poor functional outcome.