Acute Compartment Syndrome after Lower Leg Fracture: Long-Term Results of Prophylactic and Therapeutic Fasciotomy

Background: In acute situations, fasciotomy can be done prophylactically or as early therapeutic decompression, the latter being performed as soon as the first symptoms of compartment syndrome are present. Patients and Methods: Results of fasciotomy after lower leg fracture performed between 1992 and 2001 were reviewed with emphasis on the efficacy of treatment and morbidity of the procedure sec. Patients, divided into a prophylactic group (A) and a therapeutic fasciotomy group (B), were interviewed and examined, focusing on late sequelae of compartment syndrome and of the fasciotomy sec. Results: 52 patients were followed up after a median period of 40 months, 18 in group A and 34 in group B. All fractures in group A were operated within 24 h, one third of patients in group B underwent surgery later. In group A, one short foot syndrome was found. In group B, five amputations were performed for ischemic muscle necrosis, two short foot syndromes were observed, and five legs showed other late compelling signs of manifest compartment syndrome. In the 31 legs without sustained compartment syndrome, only seven had no fasciotomy-related abnormalities besides a scar; reduced endurance and swelling were most frequently found. An iatrogenic superficial peroneal nerve lesion was diagnosed in seven legs. Conclusion: Outcome after prophylactic fasciotomy seems to be superior to that after early therapeutic decompression. Though prophylactic fasciotomy is effective, its morbidity is quite high, with long-term consequences in three quarters of patients.