Chng E, Satkunanantham M, Kang Y C, Sechachalam S
Department of General Medicine, Khoo Teck Puat Hospital, Singapore.
Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore.
Malays Orthop J. 2023 Jul;17(2):28-34. doi: 10.5704/MOJ.2307.005.
Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases.
A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed.
The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases.
This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limb-salvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.
早在20世纪80年代就有关于闭合性胫骨骨折髓内钉固定术后并发骨筋膜室综合征的描述，但与创伤后直接发生的骨筋膜室综合征相比，目前文献中对此的描述仍较少。本研究旨在通过回顾三例病例，对这种可能导致残疾的并发症进行综述，并强调骨折固定后（不仅仅是骨折本身之后）及时诊断和处理骨筋膜室综合征的重要性。
对一系列三例病例进行回顾性研究。记录骨折类型、至固定的等待时间、手术时长、扩髓情况、所用髓内钉植入物的尺寸、止血带时间和手术技术。分析骨筋膜室综合征的诊断时间、如有可用的骨筋膜室内压力、肌肉坏死程度、进行的重建手术以及术后并发症。
这三例病例均为2010年1月至5月因道路交通事故导致的高能创伤。所有病例均在术后1至6天临床诊断为骨筋膜室综合征，三例中有两例通过骨筋膜室内压力测量升高得到支持。
本研究提倡对胫骨干骨折行髓内钉固定术后的患者进行全面的临床监测，并始终高度怀疑其发生骨筋膜室综合征，以便及时进行挽救肢体的干预。虽然骨筋膜室内压力可用于辅助诊断，但我们不建议单独使用它来诊断骨筋膜室综合征。肌腱转移可改善功能活动度，对于肌肉严重损伤的患者效果良好，而对于肌肉损伤轻微的患者，植皮即可。
