Sacramento, CA, 10/27/2015 /SubmitPressRelease123/
Acute compartment syndrome in the lower extremity occurs as a consequence of dashboard type injures in high impact motor vehicle accidents and is associated with tibial fractures, severe soft tissue injuries, or in the setting of prolonged extraction of an injured person in a crushed vehicle that leads to compression of the arterial and venous supply to the lower extremity. These injuries together or in isolation can lead to an acute compartment syndrome that causes an increase in pressures in various compartments of the lower extremity that interferes with blood supply to the tissues. The potential disabling complications include infection, contractures of the joints, reflex sympathetic dystrophy, nerve injuries, and amputations.
The limb saving surgery that is required is called a fasciotomy that basically results in a leg that is filleted opened along the tissue planes exposing the compartments to the air, which will allow for the resumption of blood perfusion to the tissues to the compartment and to those distal to the compartment.
Often during the fasciotomy the orthopedic trauma surgeons will proceed with repairing the various bony and ligamentous injuries which often include tibial plateau fractures, and foot/ankle injuries resulting in a patient with open wounds, bony injuries with restrictions on weight-bearing to allow for healing, and painful wound care to the lower extremity. Only after the tissues in the compartments are determined to be clean of dead tissue, free of infections, and with adequate blood supply will surgical closure with skin grafts be performed that are harvested from the patient’s back or thigh and applied to the fasciotomy sites.
More often than not following acute hospitalization the patient with the mangled extremity will require inpatient rehabilitation, and then months of outpatient physical therapy to learn how to walk while dealing with the consequences of stiff joints, nerve injuries, and loss of muscle strength. The process is costly and will require months of uninterrupted therapy, transportation, orthotic devices, medications, diagnostic tests, medical follow-ups, and adaptive equipment. Issues related to depression, post-traumatic stress disorder from the trauma, and narcotic dependence related to prolonged use often require long-term treatments with a clinical psychologist.
For those with associate brain injuries or limited financial means active medical case management is required to ensure all recommended treatments are received without interruption, and any symptom or signs of complications are treated timely.
After the ‘full physical recovery’ there often is the need for vocational rehabilitation to allow for job retraining to ensure future economic viability. Finally, there will be a need to determine the future care with a valid physician derived life care plan to determine the timing of joint replacements as one develops post-traumatic arthritis and the other associate cost of care as one ages with a disabling injury.
Dr. Greg Vigna, MD, JD
Connect with Dr. Greg Vigna, MD, JD
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