[Compartment syndrome in fractures of the shin]

Compartment syndrome represents the most serious complication in the treatment of the fractures of the shin. In the period 1979-1987 17 patients with variously developed form of the compartment syndrome were treated at the Orthopaedic clinic of the Institute for In-service Education of Physicians. 7 patients, i. e. 40 per cent were transported from other clinics. There were 8 open fractures in the group, i. e. 47 per cent, and they were classified according to Allgöwer. All patients were primarily operated on for the fracture of the shin and the compartment syndrome occurred in 11 cases after plate osteosynthesis and in 6 cases as a result of the implementation of an external fixation device. Early fasciotomy in the interval up to two hours after the manifestation of the syndrome was done only in two patients, in three cases fasciotomy was not done at all. From the viewpoint of the types of decompression bilateral incision was done in five cases and parafibular decompression in 7 cases. Restitutio ad integrum after the syndrome does not exist. Results of the treatment range from the healing with the defect of soft tissues to the amputation which was performed in two patients. In the evaluation of surgical errors resulting in the development of the syndrome primary closure of operational wound ranks the first place. In the evaluation of the general biological condition of the organism in 66 per cent polyglobulia and hypalbuminemy were found as an expression of a poor biological condition of the organism and chronic hypoxy. The necessity was stressed of the evaluation of the condition of soft tissues and their contamination and their adequate treatment. The possibility was pointed out of hyperbaric oxygenation as a still neglected component of the causal therapy.