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Scientific Articles   |    
Injury Patterns Causing Isolated Foot Compartment Syndrome
Nikhil A. Thakur, MD1; Matthew McDonnell, MD1; Christopher J. Got, MD1; Nicole Arcand, MD2; Kevin F. Spratt, PhD3; Christopher W. DiGiovanni, MD1
1 Department of Orthopaedics, Rhode Island Hospital/Brown University, 2 Dudley Street, Providence, RI 02903. E-mail address for N.A. Thakur: nthakur79@gmail.com
2 Norwich Orthopaedic Group, 82 New Park Avenue, North Franklin, CT 06254
3 Department of Orthopaedics, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756
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Investigation performed at the Department of Orthopaedics, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 06;94(11):1030-1035. doi: 10.2106/JBJS.J.02000
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Abstract

Background: 

The true incidence and primary predictors of foot compartment syndrome remain controversial. Our aim was to better define the overall incidence of foot compartment syndrome in relation to the frequency and location of various foot injuries. We hypothesized that (1) the incidence would increase in proportion to the number of anatomic locations of injury, (2) the incidence would be higher in association with hindfoot and crush injuries compared with any other injury categories, and (3) not only would the incidence associated with calcaneal fractures be lower than the often quoted 10% but foot compartment syndrome would also be fairly uncommon after such fractures.

Methods: 

The National Trauma Data Bank was used to identify patients who had undergone a fasciotomy for the treatment of isolated foot compartment syndrome. Strict inclusion and exclusion criteria were used to identify only patients with foot injuries who had undergone fasciotomy for foot compartment syndrome.

Results: 

Three hundred and sixty-four patients with an isolated foot compartment syndrome were identified. The highest incidence of foot compartment syndrome was seen in association with a crush mechanism combined with a forefoot injury (18%, nineteen of 106), followed by an isolated crush injury (14%, twenty-three of 162). Only 1% (thirty-two) of 2481 patients with an isolated calcaneal fracture underwent fasciotomy. An increase in the number of anatomic locations of injury did not appear to correspond to an increased incidence of foot compartment syndrome.

Conclusion: 

Our results demonstrate that injuries involving a crush mechanism, either in isolation or in combination with a forefoot injury, should raise suspicion about the possibility that a foot compartment syndrome will develop.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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