[Prophylactic fasciotomy in tibial osteotomies: functional results]

Intramedullary nailing in tibial osteotomy (TO) can be combined with minimally invasive prophylactic fasciotomy (PF) of the anterior compartment of the lower leg to prevent postoperative acute compartment syndrome (CS). So far no studies are available on the effects of TO or PF on specific functions of the extensor muscles.

To investigate the medium-term outcome after PF in TO in patients without preoperative functional impairment.

In 41 cases (28 women, 13 men) the patients were questioned with respect to clinical function on average 6.1 years after elective TO and PF fixed with intramedullary nails. Of the cases 23 were examined measuring isometric strength and range of motion (ROM) of dorsiflexion (DF) of the foot. Strength was compared to the 10% standard percentile to test for clinical relevance and to the contralateral side if applicable.

In an average of 86% of the cases no or minor functional impairment of the extensors was reported. The DF of the foot was rated as the leading impairment. Mean strength did not differ significantly from the gender-specific 10% standard percentiles but was significantly lower on the operated side with 16.0 ± 6.5 kgf compared to the healthy side with 17.5 ± 6.3 kgf (p < 0.01). Subjective impairments of DF of the foot correlated clearly negatively with ROM (r_s = -0.46, p < 0.05) but not with strength.

The results indicate a low occurrence of subjectively relevant functional impairment of the extensor muscles. The decrease of strength was not found to be clinically relevant. Subjective impairments appeared to be caused by a decrease of ROM, not strength.