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Acute traumatic compartment syndrome: a systematic review of results of fasciotomy

Pain Research, Nuffield Department of Anaesthetics, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, UK

Dominic J Aldington

Pain Research, Nuffield Department of Anaesthetics, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, UK

R Andrew Moore

Pain Research, Nuffield Department of Anaesthetics, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, OX3 9DU, UK, andrew.moore{at}nda.ox.ac.uk

Issues around diagnosis and treatment of acute compartment syndrome were investigated through a systematic review that examined results of 55 reports of fasciotomy published over four decades and reporting on 1920 fasciotomies. Most were reported since 2000. Injuries below the elbow and knee accounted for at least 75% of cases. The consensus was that diagnosis of compartment syndrome remains primarily based on a high index of suspicion and interpretation of clinical signs and symptoms over high technology methods of diagnosis. Compartment syndrome related amputation occurred in 5.5% of cases and death in 3.3% overall. Compared with fasciotomy before 6 h, delayed fasciotomy beyond 12 h was associated with a lower rate of acceptable outcome (15% for more than 12 h vs. 88% for <6 h), a higher rate of amputation (14% vs. 3.2%) and death (4.3% vs. 2.0%).

Key Words: fasciotomy • acute compartment syndrome • systematic review

Trauma, Vol. 11, No. 1, 5-35 (2009)
DOI: 10.1177/1460408608099028


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