Issues in the Management of Fractures associated with Compartment Syndrome

Vetri Ganapathy, T (2012) Issues in the Management of Fractures associated with Compartment Syndrome. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Compartment syndrome has been identified as an acute devastating orthopaedic emergency. Till date, compartment syndrome is one of the major complications in an injured limb. And early fasciotomy is the only way to prevent any complications due to compartment syndrome. Delay in diagnosis had been identified as the only cause of failure of treatment. This retrospective study proposes to analyse the issues in management of fractures complicated by compartment syndrome occurring preoperatively and post-operatively. AIM OF THE STUDY: To retrospectively study the issues in management of fractures complicated by compartment syndrome occurring pre-operatively, and post-operatively OBJECTIVES: 1. To study the issues involved in the rationale for deciding the method of fracture stabilization following fasciotomy. 2. To study the problems, complications and functional outcome of fracture stabilization. 3. To analyze and establish methods to the optimally manage the issues involved. MATERIALS AND METHODS: A review of patients admitted in the Orthopaedic department at our institution from January 2005 to December 2010 was carried out. Patients who presented with or developed compartment syndrome and associated with fractures were chosen. Compartment syndrome was diagnosed clinically in all the cases, except one. Passive stretch pain and severe pain out of proportion were the main clinical indicators considered. Paraesthesia, paralysis and pulselesness were considered to be supportive of the diagnosis. Compartment pressure was measured in one patient who had a spinal injury. Decision to perform fasciotomy was carried out based on the Δp value. Δp was calculated by the difference between the patient’s diastolic pressure and compartment pressure. Fasciotomy is indicated if the value was less than 30mm Hg. All the patients who had developed compartment syndrome of the leg were treated with double incision faciotomy, Anterolateral and Posteromedial. Compartment syndrome of forearm was treated with single volar incision fasciotomy, while that of thigh also was treated with a single lateral incision. The fractures were treated with external, internal or hybrid fixation. The fasciotomy wounds were taken up for secondary closure from 4 to 7 days after fasciotomy with split skin grafting. Patients were followed up every month for the first 6 months and then every 6 months. All the patients, who were reviewed, were functionally assessed based on Upper Extremity Functional Index (UEFI) and Lower Extremity Functional Scale (LEFS). Painless unprotected weight-bearing and presence of bridging callus on X-ray were together considered as signs of bony union. RESULTS: There were 21 patients who were diagnosed with compartment syndrome and underwent fasciotomy for the same. But compartment syndrome in 2 of the patients (one male and female; Cases 4 & 5, Master Chart) were not associated with fractures and hence excluded from the study. CONCLUSION: A high suspicion of compartment syndrome must be maintained for all cases. ❖ The early diagnosis and treatment within 12 hours is critical to reduce morbidity and prevent any long term sequale. ❖ Compartment syndrome causes delay in bone healing ❖ Risk of infection is not increased. ❖ External fixation is the method of choice in metaphyseal and metaphyseal-diaphyseal fractures and fractures without adequate soft tissue cover, when associated with compartment syndrome. ❖ Hybrid fixators with intrafragmentary screw fixation are used in juxta-articular fractures with communition. ❖ As bony healing is not compromised in any way, use of intramedullary fixation is not contraindicated in diaphyseal fractures associated with compartment syndrome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Compartment Syndrome, Fractures, Management.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 21 Sep 2017 03:33
Last Modified: 14 Sep 2020 17:25

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