SLR - May 2013 - Corine L. Creech
Reference: Packer JD, Day MS, Nguyen JT, Hobart SJ, Hannafin JA, and Metzl JD. Am J Sports Med, 2013 Feb; 41 (2) 430-6.
Scientific Literature Review
Reviewed by: Corine L. Creech, DPM
Residency Program: Temple University Hospital
Podiatric Relevance: Chronic exertional compartment syndrome is a painful condition with long term physical ramifications that may ultimately need to be treated surgically with fasciotomy. Because of the paucity of available data, indications and techniques for surgical management are difficult to apply in the clinical setting. Fasciotomy rates of failure can reach as high as 20 percent. This may be attributable to compounding factors including age, sex, compartments released, post-exertion compartment pressure, and duration of symptoms. The authors of this cohort study hypothesized that better success and patient satisfaction would correspond with higher preoperative post-exertion compartment pressures.
Methods: Over a nine-year period, patients who failed conservative management of chronic exertional compartment syndrome underwent pre- and post-exertion compartment pressure measurements. They were then given the option to either continue with non-surgical management, or to undergo surgical intervention consisting of fasciotomy. Patients who met the inclusion criteria were then given a telephone questionnaire detailing their symptoms, satisfaction and response to treatment.
Results: The operative group (n=73) had a higher success rate (81 percent) than did the non-operative group (n=27; 41 percent), as well as reported satisfaction rate (81 percent vs. 56 percent). Interestingly, there was no correlation found between compartment pressures and patient outcomes. Those patients who underwent single anterior compartment release had a decreased failure rate (0 percent) compared to those with an anterior and lateral compartment release (31 percent). High school and college aged postoperative patients seemed to also fare better than their post-college counterparts.
Conclusions: Overall, favorable outcomes were seen with fasciotomy with minimal complication rates. However, the results of this study failed to demonstrate a correlation between increased compartment pressure and higher satisfaction rates. The authors did note that patients who were younger, and those with isolated anterior compartment symptoms, had better results than did their counterparts.