Complications Following Unilateral Fasciotomy for Compartment Syndrome of the Lower Leg

Arnold Suda 1 Christian Abt 1 Yoram Weil 2 Amal Khoury 2
1Department of Trauma and Orthopaedics, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
2Department of Orthopedic Surgery, Hadassah Medical Center, Jerusalem, Israel

Unilateral fasciotomy for the Treatment of compartment Syndrome is a Standard procedure but requires experience and can lead to severe complications. Different from the bilateral fasciotomy, all compartiments are opened from lateral side using one Long incision. Aim of this retrospective study was to evaluate the results of this procedure and to identify risk factors for complications.

204 patients (173 males, 28 females) were included in this study with a mean Age of 40 years (10 - 91) who developed a compartment Syndrome of the lower leg following an open or closed lower leg fracture, ankle fracture, contusion of the lower leg or without Trauma. Patients were evaluated clinically until discharge in case of no complications or up to one year in the case of complications.

201 patients were evaluated. 84 Patients (41.8%) developed complications, mostly wound healing Problems (46.4%), partial muscle necrosis (36.9%), disturbance of sensitivity (32.1%), pain (20.2%) and peroneal nerve lesion (19%). Two revisions (1 - 11) were needed until wound closure was reached, including scheduled Change or removal of vacuum assisted closure dressing. There was no statistical significant difference regarding comorbidities in patients with or without complications.

Unilateral fasciotomy is a limb preserving procedure in the case of manifest compartment Syndrome of the lower leg. The results of this study Show the high rate of complications with 19% of peroneal nerve lesions. Although the lower leg injury can cause nerve injury itself, the unilateral technique contains the risk of iatrogenic nerve injury. Evaluating our results, the bilateral faciotomy using smaller incisions on the lateral side might prevent nerve injuries.