TY - JOUR
T1 - Effectiveness of foot fasciotomies in foot and ankle trauma
AU - Bedigrew, Katherine M.
AU - Stinner, Daniel J.
AU - Kragh, J. F.
AU - Potter, B. K.
AU - Shawen, S. B.
AU - Hsu, J. R.
N1 - Funding Information:
This study was conducted under a protocol reviewed and approved by the US Army Medical Research and Materiel Command Institutional Review Board, and in accordance with the approved protocol. We performed a retrospective case-control study comparing a group of service members who sustained severe lower extremity trauma and underwent foot fasciotomies to a group of service members who also sustained severe foot trauma but did not receive foot fasciotomies. The study population was identified by searching International Classification of Diseases, Ninth Revision (ICD.9) codes for compartment syndrome from the Department of Defense Trauma Registry (DoDTR), a military trauma database of soldiers injured in Iraq and Afghanistan. The medical records were then reviewed to determine which patients had compartment syndrome in the foot and underwent foot fasciotomies from 1 January 2007 to 30 June 2009. All patients with a diagnosis of foot compartment syndrome, who underwent foot fasciotomy, were included in our study. Patients were diagnosed with acute compartment syndrome of the foot either by clinical examination or pressure measurements. All patients treated with fasciotomy were unable to have their fasciotomy wounds closed within 48 hours post
Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017.All rights reserved.
PY - 2017/10
Y1 - 2017/10
N2 - Background Foot compartment syndrome (FCS) has been reported to cause neuropathic pain, claw or hammer toes, and motor and sensory disturbances. The optimal treatment of FCS is controversial. The purpose of this study was to determine if foot fasciotomies improve patient outcomes in high-energy, combat-related lower extremity trauma. Methods Medical records of patients with documented FCS from May 2007 to January 2009 were retrospectively reviewed. Consecutive, matched control patients were identified based on similar hindfoot, mid-foot and/or forefoot injuries who did not undergo foot fasciotomy during the same period. The primary outcomes analysed were the development of claw or hammer toes and neuropathic pain. Results 19 patients with foot fasctiotomies were identified and matched with 19 controls. Median follow-up was 19.5 months (range, 3.5-47.5 months) for the combined cohorts. The most common mechanism of injury was an explosive blast. Nine fasciotomy and nine control patients sustained open foot fractures. Significantly more patients with foot fasciotomies developed claw toes (50% vs 17%, p=0.03). There were no significant differences in the development of neuropathic pain, sensory deficits, motor deficits, chronic pain, stiffness or infection. The fasciotomy patients underwent an average of 5.5 surgeries per patient versus 4 surgeries per patient in the control group. Conclusions Fasciotomy of the foot did not prevent neuropathic pain and deformities in patients with FCS in this study.
AB - Background Foot compartment syndrome (FCS) has been reported to cause neuropathic pain, claw or hammer toes, and motor and sensory disturbances. The optimal treatment of FCS is controversial. The purpose of this study was to determine if foot fasciotomies improve patient outcomes in high-energy, combat-related lower extremity trauma. Methods Medical records of patients with documented FCS from May 2007 to January 2009 were retrospectively reviewed. Consecutive, matched control patients were identified based on similar hindfoot, mid-foot and/or forefoot injuries who did not undergo foot fasciotomy during the same period. The primary outcomes analysed were the development of claw or hammer toes and neuropathic pain. Results 19 patients with foot fasctiotomies were identified and matched with 19 controls. Median follow-up was 19.5 months (range, 3.5-47.5 months) for the combined cohorts. The most common mechanism of injury was an explosive blast. Nine fasciotomy and nine control patients sustained open foot fractures. Significantly more patients with foot fasciotomies developed claw toes (50% vs 17%, p=0.03). There were no significant differences in the development of neuropathic pain, sensory deficits, motor deficits, chronic pain, stiffness or infection. The fasciotomy patients underwent an average of 5.5 surgeries per patient versus 4 surgeries per patient in the control group. Conclusions Fasciotomy of the foot did not prevent neuropathic pain and deformities in patients with FCS in this study.
UR - http://www.scopus.com/inward/record.url?scp=85030784393&partnerID=8YFLogxK
U2 - 10.1136/jramc-2016-000734
DO - 10.1136/jramc-2016-000734
M3 - Article
C2 - 28341786
AN - SCOPUS:85030784393
SN - 0035-8665
VL - 163
SP - 324
EP - 328
JO - Journal of the Royal Army Medical Corps
JF - Journal of the Royal Army Medical Corps
IS - 5
ER -