The literature heavily focused on techniques for decompression of the anterior compartment, as it is assumed that the anterior compartment of the leg is most frequently affected 9, 10. This is because they have shown low recurrence rates and allow a faster return to sports activities 7, 8. Minimally invasive techniques are gaining popularity. Success rates for these procedures are between 52 and 100% 4, 5, 6. The literature varies widely on postoperative outcomes for fasciotomies in CECS but are acceptable. The treatment of choice, after failed conservative management, is surgical fasciotomy 3. Furthermore, the longer decompression is delayed, the greater will be the degree of functional loss 1.Ī rare but accepted clinical diagnosis in runners and military recruits is a chronic exertional compartment syndrome (CECS) 2. Surgical decompression of the lower leg for acute compartment syndrome is the only reliable way to prevent the late sequelae of ischemic contracture if it is done in time. Two incision minimally invasive fasciotomy to decompress the anterior and peroneal compartments of the lower leg appears to be safe with regard to the results of this study. More precisely, in these cases the medial dorsal cutaneous nerve got injured during the fascial opening of the extensor compartment. Two nerve injuries of the superficial peroneal nerve were reported. Release of the anterior and peroneal compartments was successful in all specimens. The second incision was made at the mid-point of the Fibula (half-way between the fibular head and the lateral malleolus). The first incision was made 12 cm proximal to the lateral malleolus to identify and protect the superficial peroneal nerve (SPN). Forty lower extremities from 20 adult cadavers, embalmed with Thiel’s method, were subject to fasciotomy of the anterior and peroneal compartment using a dual-incision minimally invasive fasciotomy. If clinicians have a clear understanding of the patients at risk it will improve our ability to diagnose and treat these patients appropriately with decompression and maintain their ability to function within the military.To evaluate the risk of iatrogenic injury when using a dual-incision minimally invasive technique to decompress the anterior and peroneal compartments of the lower leg. Delayed diagnosis will result in permanent disability and the need for multiple surgeries and ultimately discharge from military duty. As shown in case one, a timely diagnosis and emergent decompression can result in favorable outcomes. Awareness and understanding of this phenomenon will allow clinicians to make a more timely diagnosis. This case series brings to attention that highly repetitive and prolonged activities requiring sustained ankle dorsiflexion and therefore activation of the anterior tibialis and peroneal musculature can serve as a mechanism for development of acute compartment syndrome. The diagnosis is extremely rare and often not considered in the diagnosis of a non-trauma patient. KeywordsĪcute compartment syndrome is a rare diagnosis even in the setting of trauma. Overall, patients with upper extremity, hand, foot and paraspinal acute exertional compartment syndrome have a good prognosis, while those with acute exertional compartment syndrome of the leg have a poor prognosis regardless of the timing of surgery. We compare these patients to others with acute exertional compartment syndrome previously reported in the literature. The final patient had no myonecrosis, but continued to have superior peroneal nerve irritation. Two of these patients had myonecrosis of the anterior and lateral compartments, requiring posterior tibial tendon transfers. In this paper we review 3 consecutive patients that presented with acute compartment syndrome after performing walking events during training in the United States Army. Rarely, walking or low impact, highly repetitive activities are implicated. Common etiologies include high energy trauma and extravasation or bleeding events. Acute compartment syndrome (ACS) is a devastating condition related to increased pressures within fascial compartments.
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