Long-Term Outcomes of Fasciotomy for Acute Compartment Syndrome After a Fracture of the Tibial Diaphysis.

OBJECTIVES

To evaluate the short- and long-term patient-reported outcomes of acute compartment syndrome (ACS) complicating a fracture of the tibial diaphysis.

DESIGN

A retrospective review.

SETTING

Academic orthopaedic trauma center.

PATIENTS: We retrospectively identified 559 patients from a trauma database over a 7-year period. Forty-one patients (7.3%) underwent fasciotomies for ACS and were included in the study. A matched cohort of 185 patients who did not develop ACS was used as controls.

INTERVENTION: Fasciotomy for ACS.

MAIN OUTCOME MEASUREMENTS: The primary short-term outcome measure was the development of complications, including infection, nonunion, and further surgery. The primary long-term outcome measure was the patient-reported EuroQol-5D-3L (EQ-5D). Secondary long-term outcomes included the Oxford Knee Score, the Manchester-Oxford Foot Questionnaire, and satisfaction.

RESULTS

There was no significant difference between ACS and non-ACS groups in the overall rate of infection (17% vs. 9.2%, respectively; P = 0.14), deep infection (4.9% vs. 3.8%; P = 0.67), or nonunion (4.9% vs. 7.0%; P = 1.00). There were 206 patients (21 ACS) with long-term outcome data at a mean of 5 years (1-9). There was no significant difference between groups about the EQ-5D (P = 0.81), the Oxford Knee Score (P = 0.24), or the Manchester-Oxford Foot Questionnaire (P = 0.63). Patient satisfaction was reduced in patients who developed ACS (77 vs. 88; P = 0.039).

CONCLUSION

These data suggest that when managed with urgent decompressive fasciotomies, ACS does not seem to have a significant impact on the long-term patient-reported outcome although patient satisfaction is reduced.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.