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

Abstract

Background: This study aims to determine the cause, spectrum and outcomes of acute fasciotomy for compartment syndrome in a developing world setting. This study serves as an overview of the Pietermaritzburg Metropolitan Trauma Service (PMTS) experience of acute fasciotomy.

Methods: All patients who underwent a fasciotomy between December 2012 and September 2020 were identified from the Hybrid Electronic Medical Registry (HEMR).

Results: During the eight-year period under review, a total of 97 patients required fasciotomy. The mean age was 27.96 years. Of these patients, 88% (85/97) were male and 12% (12/97) were female. There were 57 penetrating injuries, 23 snakebite-related injuries and 17 blunt trauma-related injuries resulting in compartment syndrome requiring fasciotomy. Of these, 52% of injuries involved the lower limb and 47% involved the upper limb, with 1% involving an injury to both upper and lower limbs. The average hospital stay was 12 days, and the mortality rate was 3%.

Conclusion: A broad range of injuries may precipitate acute compartment syndrome (ACS) of the extremity and mandate fasciotomy. Clinicians must actively exclude ACS when managing these conditions. Once identified, ACS requires fasciotomy. In an environment with long prehospital times there seems to be little role for expectant treatment of ACS.