Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study

Journal of Orthopaedic Surgery and Research, Apr 2013

Background Intracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief. Methods A standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years. Results Follow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0 ± 1.5 to 2.3 ± 2.1, P < 0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL. Conclusions The diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction.

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Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study

Journal of Orthopaedic Surgery and Research Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study Jan Roar Orlin 0 1 Jarle en 3 John Roger Andersen 1 2 0 Section for Orthopedic Surgery, Department of Surgical Sciences, University of Bergen , Bergen , Norway 1 Department of Orthopedics, Frde Central Hospital (FSS) , N-6807 Frde , Norway 2 Department of Health studies, Sogn and Fjordane University College , N-6803 Frde , Norway 3 Department of Anesthesiology, Frde Central Hospital , N-6807 Frde , Norway Background: Intracompartmental pressure (ICP) as the diagnostic gold standard in the management of chronic compartment syndrome (CCS) is debated. We present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The aim of this study was to examine whether patients who underwent surgery for CCS based on clinical findings experienced significant long-term pain relief. Methods: A standardized clinical examination, including skin sensitivity, was performed in patients with bilateral leg pain and/or cramps. Before and after a symptom-provoking step test, ICPs were measured. The primary outcome was self-reported leg pain measured on a visual analogue scale. Secondary outcomes were satisfaction with the treatment result and health-related quality of life (HRQL) measured with the SF-8 questionnaire. Postoperative data were collected after 2 years. Results: Follow-up was completed for 37 of 40 patients. ICP was increased in 80.5% of the compartments examined before surgery, but did not correlate with the degree of leg pain. The remaining compartments were diagnosed as CCS based on clinical findings, despite ICPs below the threshold. Leg cramps occurred in 32 of 37 (86.5%) patients during physical activity and at night. Leg pain improved from a score of 8.0 1.5 to 2.3 2.1, P < 0.001. Satisfaction with the treatment result was reported by 81.1% of the patients, accompanied by normalized HRQL. Conclusions: The diagnostic protocol led to a fasciotomy in all compartments of both legs, which was associated with substantial and sustained relief of leg pain, improved HRQL, and patient satisfaction. Pain; Quality of life; Fasciotomy and Chronic Compartment Syndrome - Introduction Chronic compartment syndrome (also known as chronic exertional compartment syndrome) is a disorder that is most often encountered and described in soldiers and athletes [1-5], but it has also been reported in nonathletes [6]. CCS is characterized by leg pain that is serious enough to prohibit running and sometimes even walking. The pathophysiology of CCS is unknown, but reduced microcirculation capacity and increased ICP has been documented [2,7]. Small observational studies provide limited evidence that as many as 13.9% of leg pain of unknown cause may be related to CCS, while as many as 82% of cases referred for suspected CCS may have elevated ICP [1]. CCS has been documented to occur in the anterior and lateral compartments, and surgical treatment has been directed mainly towards the anterior compartment in the presence of appropriate clinical findings. Recently, CCS was reported in the posterior compartments as well [8]. To establish a diagnosis of CCS, measurement of ICP 15 mm Hg at rest and 30 mm Hg 1 minute after exercise has been considered necessary [1,3]. However, a recent review suggested that this diagnostic gold standard for CCS is flawed and recommended that clinicians use protocol-specific upper confidence limits to guide their diagnosis [2]. Thus, clinical practice related to referral for fasciotomy often differs. A diagnosis of CCS that requires fasciotomy may be based on clinical findings only [1], but minimal or comprehensive ICP testing is usually also performed [9,10]. Results after fasciotomy are often good, but for lasting pain relief, decompression of an increasing number of leg compartments may be necessary, paralleling the complete compartmental decompression recommended for acute cases. Poor long-term results may be related to incorrect diagnosis or failure to address multiple compartments in the leg simultaneously [11]. Further exploration of the role of ICP as the diagnostic gold standard and other diagnostic approaches in the management of the CCS appear to be indicated. In this paper, we present a diagnostic protocol in which the decision to operate can be based upon clinical findings alone. The primary aim of this study was to examine whether patients who underwent surgery for CCS, based upon this diagnostic approach, experienced significant long-term pain relief. Satisfaction with the treatment results and health-related quality of life (HRQL), measured with the SF-8 questionnaire, were secondary outcomes. Materials and methods Study design and patients In this case series study, 43 patients with suspected CCS in both legs were examined in a 2-year period (August 2007 to November 2009). Twenty-seven patients with (...truncated)


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Jan Roar Orlin, Jarle Øen, John Roger Andersen. Changes in leg pain after bilateral fasciotomy to treat chronic compartment syndrome: a case series study, Journal of Orthopaedic Surgery and Research, 2013, pp. 6, 8, DOI: 10.1186/1749-799X-8-6