Extremity fasciotomy in the developing world setting - a South African experience

Area of Science:

• Trauma Surgery
• Orthopedic Surgery
• Emergency Medicine

Background:

• Acute compartment syndrome (ACS) is a surgical emergency requiring fasciotomy.
• Understanding the causes and outcomes of ACS is vital, particularly in developing regions.
• This study reviews the Pietermaritzburg Metropolitan Trauma Service (PMTS) experience with acute fasciotomy.

Purpose of the Study:

• To determine the causes, spectrum, and outcomes of acute fasciotomy for compartment syndrome.
• To provide an overview of the Pietermaritzburg Metropolitan Trauma Service (PMTS) experience with acute fasciotomy in a developing world setting.

Main Methods:

• A retrospective review of patients who underwent fasciotomy between December 2012 and September 2020.
• Data was collected from the Hybrid Electronic Medical Registry (HEMR).

Main Results:

• 97 patients required fasciotomy over an eight-year period.
• The majority of patients were male (88%) with a mean age of 27.96 years.
• Common causes included penetrating injuries (57), snakebites (23), and blunt trauma (17), predominantly affecting lower limbs (52%).

Conclusions:

• A wide range of injuries can lead to ACS necessitating fasciotomy.
• Clinicians should actively rule out ACS in relevant trauma cases.
• Given long prehospital times, immediate fasciotomy is indicated for diagnosed ACS, with little role for expectant management.