Sudarsana GopalanManipal Hospital, India
Title: Outcome of proximal tibial fractures with and without prophylactic percutaneous fasciotomy - A comparative study
Tibial plateau fractures are always a complex fracture in terms of reduction, various methods of fixations depending upon the fracture pattern and the soft tissue condition and finally the various complications due to the fractures itself and due to the surgery. The major complications include delayed wound healing, infections, delayed rehabilitation and progression to osteoarthritis, whereas dreadful complications of these fractures are vascular injury and acute compartment syndrome. These complications are attributed to the increased intra compartmental pressure. Thus, relieving the pressure will prevent and reduce these complications. In our study we compare the outcome of fracture fixation with or without the percutaneous fasciotomy.
Materials and Methods
Our study includes cases of proximal tibial fractures, divided into two groups, with or without percutaneous fasciotomy (PCF) along with the fracture fixation. Fracture fixation was done based on the type and pattern of the fracture. After the fracture fixation, percutaneous fasciotomy was done [Fig1]. On an average 5-6 stab incisions were made with number 11 stab knife in all the compartments of the leg. Functional outcome was assessed in both the groups. Pain, swelling, knee and ankle movements, wound healing, development of CRPS were assessed in both groups.
In all the patients with percutaneous fasciotomy, we were able to relieve the compartmental pressure. We were able relieve pain significantly in all the patients within mean time of 6 hours after surgery. The requirements of analgesics were significantly less in this group compared to the group without PCF. Mean healing time of the wound was 10 days and there were no wound related complications in PCF group.
Percutaneous fasciotomy can be routinely performed along with the fixation of proximal tibia fractures considering the significant reduction of the complications due to the fracture and the surgery itself, and also as a definitive management for the cases with impending compartment syndrome. In cases of impending compartment syndrome, percutaneous fasciotomy can arrest the progression of compartment syndrome and extensive fasciotomy was prevented. Thus, the need for secondary wound procedure like flap cover, skin grafting, vacuum assisted closure was not required. Definitive management of fracture can be done in the same setting with less hospital stay with good cosmetic results.