Chronic exertional compartment syndrome persists after surgery
medwireNews: A study of US military personnel reveals the burden of lower limb chronic exertional compartment syndrome, finding recurrence and disability to be common after surgery.
The research, published in the Journal of Bone and Joint Surgery, showed that symptoms returned in 44.7% of 611 patients who underwent fasciotomy of the anterior plus lateral compartments (77.4%), the posterior (2.2%), lateral (0.9%), or anterior (0.13%) compartments, or the anterior, lateral, and posterior compartments (19.4%).
Over a quarter (27.7%) of the patients were unable to return to a full range of activities after surgery, say Brian Waterman (William Beaumont Army Medical Center, El Paso, Texas, USA) and co-workers.
Revision surgery was performed in 5.9% of the patients to treat recurrent symptoms (n=35), superficial peroneal neuritis (n=4), or an untreated compartment (n=1). But just 14% of patients who had further surgery had complete resolution of symptoms and 33% were unable to return to full activity.
Surgical complications were also common, with 15.7% of patients experiencing infection, neurologic complications, wound dehiscence, seroma, hematoma, or other issues.
Overall, 17.3% of patients received a medical discharge, giving a cumulative surgery failure rate of 21.8%, the team adds. Complications occurred in 22% of discharged patients.
Multivariate analysis showed that surgical failure was significantly predicted by perioperative complications (odds ratio [OR]=1.72), limited activities (OR=2.23), and persistence of preoperative symptoms (OR=5.47).
By contrast, gender, age, use of tobacco, need for four-compartment fasciotomy, bilateral involvement, and psychiatric comorbidity had no impact on the likelihood of surgical success.
"This study represents the largest known cohort with chronic exertional compartment syndrome of the leg to our knowledge and provides valuable information on the surgical outcomes after elective fasciotomy in a physically active patient population," Waterman et al conclude.
Commenting on the finding that surgery did not achieve a successful outcome for at least one in five of the patients, and that symptoms persist in almost half, the researchers suggest: "Additional studies should be performed to evaluate the utility of evolving conservative treatment strategies, including alterations in gait mechanics during running or at-risk activity."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lynda Williams, Senior medwireNews Reporter