eMedicine Specialties > Orthopedic Surgery > Trauma

Compartment Syndrome, Lower Extremity: Follow-up

Author: Stephen Wallace, MD, Staff, Department of Emergency Medicine, Eastern Idaho Regional Medical Center
Coauthor(s): Stuart Goodman, MD, PhD, FRCSC, FACS, Associate Chairman, Professor, Department of Functional Restoration, Division of Orthopedic Surgery, Stanford University; Head, Division of Orthopedic Surgery, Stanford University Medical Center; Douglas G Smith, MD, Associate Professor, Department of Orthopedic Surgery, University of Washington, Harborview Medical Center
Contributor Information and Disclosures

Updated: Feb 9, 2009

Outcome and Prognosis

Acute compartment syndrome (CS) may have disastrous outcomes. Muscles tolerate 4 hours of ischemia well, but by 8 hours, the damage  is often irreversible. If fasciotomy is performed within 25-30 hours following onset of acute CS, the prognosis is good. Little or no return of muscle function can be expected when the diagnosis and treatment are delayed. Despite early and aggressive fasciotomy, nearly 20% of patients may have persistent sensory or motor deficits at 1-year follow-up.22

Tendon transfers and foot stabilization may be indicated as late treatment for CS, but in most patients, enough scarring and contracture eventually develop in the anterior musculature to prevent footdrop. However, a footdrop brace is indicated for the first few months following onset of CS until fibrosis occurs. Most athletes experience persistent gastrocnemius and soleus muscle weakness; this is thought to be due to the loss of the supporting compartment fascia. In a study by Awbrey, 44 of 46 patients undergoing compartment release for lower leg chronic CS had excellent pain relief with unimpaired running at 1- and 9-year follow-up.38

Future and Controversies

In cases of fasciotomy for anterior exertional CS, lateral compartment fasciotomy may not be necessary. A study by Schepsis et al demonstrated similar outcomes in athletes with chronic CS who were treated either by single-compartment or dual-compartment release.39

Compartment syndrome in women

Kaper et al have suggested that women may be more susceptible to chronic lower leg CS than men are.40

Compartment syndrome following arthroscopy

Studies by Nillius and  Rooser, Peek and Haynes, and Fruensgaard and Holm documented the incidence of CS following knee arthroscopy and evaluated fasciotomies as treatment.41,42,43 However, Kaper et al have suggested that emergency fasciotomies are not absolutely indicated.40 Rather, observation of the patient in the recovery room, with serial examinations and repeat compartment-pressure measurements, may be considered. Pressure measurements of the contralateral extremity may be useful as a control to verify the accuracy of the readings. If persistently elevated pressures are recorded or the development of clinical findings consistent with CS are noted, the patient can still be returned to the operating room within the 6 hours prior to development of irreversible myonecrosis.

 


More on Compartment Syndrome, Lower Extremity

Overview: Compartment Syndrome, Lower Extremity
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Treatment: Compartment Syndrome, Lower Extremity
Follow-up: Compartment Syndrome, Lower Extremity
Multimedia: Compartment Syndrome, Lower Extremity
References
Further Reading
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Keywords

compartment syndrome, CS, chronic CS, chronic exertional CS, exertional CS, recurrent CS, subacute CS, Volkmann ischemia, chronic exertional compartment syndrome, exertional rhabdomyolysis, recurrent compartment syndrome, subacute compartment syndrome, fasciotomy, compartment release

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Contributor Information and Disclosures

Author

Stephen Wallace, MD, Staff, Department of Emergency Medicine, Eastern Idaho Regional Medical Center
Stephen Wallace, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Stuart Goodman, MD, PhD, FRCSC, FACS, Associate Chairman, Professor, Department of Functional Restoration, Division of Orthopedic Surgery, Stanford University; Head, Division of Orthopedic Surgery, Stanford University Medical Center
Stuart Goodman, MD, PhD, FRCSC, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, California Medical Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Douglas G Smith, MD, Associate Professor, Department of Orthopedic Surgery, University of Washington, Harborview Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Steven I Rabin, MD, Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic
Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Samuel Agnew, MD, FACS, Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center
Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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