Survey of Management of Acute, Traumatic Compartment Syndrome of the Leg in Australia

Wall, Christopher J.; Richardson, Martin; Lowe, Adrian J.; Brand, Caroline; Lynch, Joan; Steiger, Richard N. de

doi:10.1111/j.1445-2197.2007.04210.x

Cited by 26 publications

(23 citation statements)

References 23 publications

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“…Its prompt diagnosis is mostly based on clinical criteria (6–9), although direct compartment pressure measurements have been used in certain clinical scenarios to confirm a suspected diagnosis (7). Once the diagnosis of an extremity compartment syndrome (ECS) is made treatment entails decompressive fasciotomy (7,8,10).…”

Section: Introductionmentioning

confidence: 99%

Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: A review of the National Trauma Data Bank

Farber

Tan

Hamburg

et al. 2012

Injury

122

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Introduction and Objectives Lower Extremity (LE) arterial trauma and its treatment may lead to extremity compartment syndrome (ECS). In that setting, the decision to perform fasciotomies is multifactoral and is not well delineated. We evaluated the outcomes of patients with surgically treated LE arterial injury who underwent early or delayed fasciotomies. Methods The National Trauma Data Bank (NTDB) was retrospectively reviewed for patients who had LE arterial trauma and underwent both open vascular repair and fasciotomies. Exclusion criteria were additional non-LE vascular trauma, head or spinal cord injuries, crush injuries, burn injuries, and declaration of death on arrival. Patients were divided into those who had fasciotomies performed within 8 hours (Early Group) or > 8 hours after open vascular repair (Late Group). Comparative analyses of demographics, injury characteristics, complications, and outcomes were performed. Results Of the 1,469 patient admissions with lower extremity arterial trauma that met inclusion criteria there were 612 patients (41.7%) who underwent fasciotomies. There were 543 and 69 patients in the Early and Late Fasciotomy Groups, respectively. There was no significant difference in age, injury severity, mechanism of injury, associated injuries, and type of vascular repair between the groups. A higher rate of iliac artery injury was observed in the Late Fasciotomy Group (23.2% vs. 5.9%, P<.001). Patients in the Early Fasciotomy Group had lower amputation rate (8.5% vs. 24.6%, P<.001), lower infection rate (6.6% vs. 14.5%, P=.028) and shorted total hospital stay (18.5±20.7 days vs. 24.2±14.7 days, P=.007) than those in the Late Fasciotomy Group. On multivariable analysis, early fasciotomy was associated with a 4-fold lower risk of amputation (Odds Ratio 0.26, 95% CI 0.14–0.50, p<.0001) and 23% shorter hospital LOS (Means Ratio 0.77, 95% CI 0.64–0.94, P=.01). Conclusion Early fasciotomy is associated with improved outcomes in patients with lower extremity vascular trauma treated with surgical intervention. Our findings suggest that appropriate implementation of early fasciotomy may reduce amputation rates in extremity arterial injury.

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Section: Introductionmentioning

confidence: 99%

Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: A review of the National Trauma Data Bank

Farber

Tan

Hamburg

et al. 2012

Injury

122

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“…A review from Canada over a 10-year period reported that 77% of plaintiffs had permanent disability and 55% of cases had a judgement for the plaintiff or an unfavourable decision for the physician, with the primary clinical issue a delay or failure to diagnose ACS [92]. Despite all this evidence highlighting the issues with a delay in the diagnosis, there remains an extraordinary lack of consistency in the clinical assessment of the condition [93,94].…”

Section: Limitations and Pitfallsmentioning

confidence: 99%

Pressure Measurement: Surrogate of Ischaemia

Duckworth

Court-Brown

McQueen

2019

Compartment Syndrome

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“…Despite the frequency with which ALCS occurs, and its associated morbidity, there are currently no management guidelines available for the condition. A recent survey revealed variation in the management of ALCS in Australia 4 …”

Section: Introductionmentioning

confidence: 99%

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma

Wall

Lynch

Harris

et al. 2010

ANZ Journal of Surgery

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Survey of Management of Acute, Traumatic Compartment Syndrome of the Leg in Australia

Abstract: There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial.

Cited by 26 publications

References 23 publications

Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: A review of the National Trauma Data Bank

Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: A review of the National Trauma Data Bank

Pressure Measurement: Surrogate of Ischaemia

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma

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