Incidence and predictors for the need for fasciotomy after extremity trauma: A 10-year review in a mature level I trauma centre
Section snippets
Background
Compartment syndrome (CS) is an important clinical entity requiring prompt diagnosis and management as delayed treatment is associated with unacceptably high rates of disability and limb loss [11], [13], [14], [15], [16], [18]. Once diagnosed, fasciotomy is necessary to release the pressure within the compartment and prevent ischemic damage to muscles and neurovascular structures. CS is usually diagnosed clinically, however compartment pressure as well as perfusion pressure monitoring has also
Methods
After IRB approval, a retrospective review of the institutional trauma registry at the Los Angeles County + University of Southern California Medical Centre was performed. All trauma patients sustaining extremity injuries admitted to our institution between 1998 and 2007 were identified. The study population was divided into two groups; patients who required a fasciotomy and those who did not.
Patient variables extracted included gender, age, injury mechanism, admission vital signs, Glasgow Coma
Results
During the 10-year study period, 10,315 (30.3%) of a total of 34,002 trauma patients admitted to the LAC + USC Medical Centre sustained extremity trauma. Of those, 288 (2.8%) required a fasciotomy (272 therapeutic and 16 prophylactic) and 10,027 (97.2%) did not (Fig. 1). Fourteen (0.1%) of 23,687 patients who did not sustain extremity trauma also required an extremity fasciotomy due to CS; these patients all had major abdominal vascular injuries. The characteristics of these patients are
Discussion
The early diagnosis of CS is important as treatment delays result not only in an increased risk of complications secondary to limb ischemia but also in a higher mortality [11], [13], [14], [15], [16], [18]. Once diagnosed, prompt fasciotomy is necessary to release the pressure inside the compartment and prevent further damage to muscles and nerves. The diagnosis of CS is primarily clinical, however, compartment pressure as well as perfusion pressure monitoring has also been used as important
Conflict of interest
We have no conflict of interest to disclose.
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