Efficacy of non-surgical interventions for promoting improved functional outcomes following acute compartment syndrome: A systematic review

Abstract

Background Acute compartment syndrome (ACS) is a devastating complication which develops following a traumatic extremity injury that results in increased pressure within osteofascial compartments, thereby leading to ischemia, muscle and nerve necrosis, and creates a life-threatening condition if left untreated. Fasciotomy is the only available standard surgical intervention for ACS. Following fasciotomy the affected extremity is plagued by prolonged impairments in function. As such, an unmet clinical need exists for adjunct, non-surgical therapies which can facilitate accelerated functional recovery following ACS. Thus, the purpose of this systematic review was to examine the state of the literature for non-surgical interventions that aim to improve muscle contractile functional recovery of the affected limb following ACS. Methods English language manuscripts which evaluated non-surgical interventions for ACS, namely those which evaluated the function of the affected extremity, were identified as per PRISMA protocols via searches within three databases from inception to February 2022. Qualitative narrative data synthesis was performed including: study characteristics, type of interventions, quality, and outcomes. Risk of bias (RoB) was assessed using the Systematic Review Centre for Laboratory Animal Experimentation’s (SYRCLE) RoB tool and reported level of evidence for each article. Results Upon review of all initially identified reports, 29 studies were found to be eligible and included. 23 distinct non-surgical interventions were found to facilitate improved muscle contractile function following ACS. Out of 29 studies, 15 studies which evaluated chemical and biological interventions, showed large effect sizes for muscle function improvement. Conclusions This systematic review demonstrated that the majority of identified non-surgical interventions facilitated an improvement in muscle contractile function following pathological conditions of ACS.

Nursing outcomes of traditional Chinese medicine adjunctive therapy on osteofascial compartment syndrome: a review†

“…The biggest challenge for OCS diagnosis is how to convince doctors regarding the effectiveness of nonsurgical treatment and the avoidance of fasciotomy as the treatment standard. 18 As reported earlier, 18 nonsurgical interventions facilitate an improvement in muscle contractile function following pathological conditions of OCS. This approach will be seen as impractical by some people, as it challenges the present view that compartment decompression should be performed in all cases.…”

Practical Review on the Contemporary Diagnosis and Management of Compartment Syndrome

“…The threshold to perform a fasciotomy should remain low, as the morbidity associated with ischemic muscle loss significantly outweighs the reduction in muscle strength and subsequent need for reoperation for closure of wound care. 23,24 Immediately following fasciotomy, primary closure may be achieved if limb edema is minimal and allows for adequate tissue reapproximation without significant tension. However, negative pressure therapy can also be placed to limit edema and the need for wound care or skin grafting as it can help prepare the extremity for delayed primary closure.…”

An Innovative Non-Invasive Method for Early Detection and Monitoring of Acute Compartment Syndrome

“…Because of its heterogeneous etiology and its complex pathology, which is still incompletely understood, this syndrome represents a redoubtable condition that even with adequate treatment may have a fatal outcome [1]. In stark contrast with these multiple considerations, the sole recommended treatment is decompressive fasciotomy [2,3].…”