CECS & Postoperative Rehabilitation Protocols in a Military Population

Research Paper Title

Outcomes of Surgery for Chronic Exertional Compartment Syndrome in a Military Population.

Aim

To determine the outcome following fasciectomy for chronic exertional compartment syndrome (CECS) in the UK military, and the association between presurgical intramuscular pressure (IMP) and outcome.

Methods

All patients who underwent fasciectomy for anterior CECS were identified between 2007 and 2010. Presurgery and postsurgery military medical grading for leg function was extracted from the medical records system. The Wilcoxon signed-rank test compared grades before and after surgery. Spearman’s rank correlation examined the relationship between IMP and outcome.

Results

Presurgery and postsurgery grading was available for 63% of patients. These patients had significantly better leg function after surgery (Z=−3.63, p<0.001). Of these, 49% improved by at least one grade, 36% showed no improvement in grading and 15% had a poorer outcome. There were no significant correlations between IMP and outcome.

Conclusions

A large proportion of patients do not return to full fitness following fasciectomy in the military population. This is in line with a recent study in the US military, but conflicts with most civilian reports. The reasons for these differences are not clear. Furthermore, the lack of a relationship between IMP and outcome questions the role of pressure in this condition. These results suggest that the role of postoperative rehabilitation protocols and other conservative options should be explored.

Reference

Roberts, A.J., Krishnasamy, P., Quayle, J.M. & Houghton, J.M. (2014) Outcomes of Surgery for Chronic Exertional Compartment Syndrome in a Military Population. Journal of the Royal Army Medical Corps. doi:10.1136/jramc-2013-000191.

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