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Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure

Goyal, Saumitra and Naik, Monappa A and Rao, Sharath K (2017) Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure. World Journal of Orthopaedics, 8 (5). pp. 385-393. ISSN 2218-5836

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Abstract

Aim : To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome (ACS) and to correlate it with functional outcome. Methods : 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. Results: 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). Conclusion: 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. Intracompartmental pressure (ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

Item Type: Article
Uncontrolled Keywords: Compartment syndrome; Leg; Tibial fracture; Deep posterior compartment; Intracompartmental pressure; Functional outcome.
Subjects: Medicine > KMC Manipal > Orthopaedics
Depositing User: KMC Library
Date Deposited: 21 Aug 2017 04:05
Last Modified: 21 Aug 2017 04:05
URI: http://eprints.manipal.edu/id/eprint/149553

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