[Prophylactic fasciotomy in tibial osteotomies: functional results]

Avoiding Compartment Syndrome, Vascular Injury, and Neurologic Deficit in Tibial Osteotomy: An Observational Study of 108 Limbs

INTRODUCTION

Tibial deformities are common, but substantial concern may be associated with corrective osteotomy regarding major complications reported in classic literature. Such studies chiefly focused on high tibial osteotomy, with relatively little investigation of other areas and types of deformity. The primary aim of this study was to identify the rate of compartment syndrome, vascular injury, nerve injury, and other major complications after elective tibial osteotomy.

METHODS

One hundred eight tibia osteotomies performed during 2019 to 2021 were evaluated, representing all tibia osteotomies except situations of existing infection. A retrospective chart review was performed to identify patient demographics, surgical indications, anatomic location of osteotomy, fixation used, and complications prompting additional surgery.

RESULTS

The most common osteotomy locations were high tibial osteotomy (35/108 = 32%, 32/35 = 91% medial opening, and 3/35 = 9% medial closing), proximal metaphysis (30/108 = 28%), and diaphysis (32/108 = 30%). The most common fixation was plate and screw (38/108 = 35%) or dynamic frame (36/108 = 33%). Tranexamic acid was administered to 107/108 = 99% of patients and aspirin chemoprophylaxis was used for 83/108 = 86%. A total of 33/34= 97% of anterior compartment prophylactic fasciotomies were performed for diaphyseal or proximal metaphysis osteotomies. No events of compartment syndrome, vascular injury, nerve injury, or pulmonary embolism occurred. One patient required débridement to address infection. Additional surgery for delayed/nonunion occurred for nine segments (8%). Additional surgery for other reasons were performed for 10 segments (9%), none resulting in reduced limb function.

CONCLUSION

Tibial osteotomy can be safely performed for a variety of indications in a diverse range of patients, without a notable risk of the most feared complications of compartment syndrome, vascular injury, and neurologic deficit. Prophylactic fasciotomy and reducing postoperative bleeding using tranexamic acid, along with location-specific safe surgical techniques, may help prevent major complications and thereby facilitate optimized deformity care.

Pain levels during distraction osteogenesis with lengthening nails in 168 cases

PURPOSE

To firstly examine the pain levels during distraction osteogenesis (DO) with lengthening nails (LN) in a large sample.

METHODS

A total of 168 cases underwent DO of the tibia or femur with five different models of LN. Under a standardized medical regime, daily pain levels were noted as nominal rating scale (NRS) score (0-10) during the distraction phase. NRS scores and several potential influence factors (LN model, bone, approach, side, age, gender) were evaluated.

RESULTS

The mean distraction length was 39.1 ± 14.4 mm. The average NRS score decreased from postoperative day 1 with 2.84 nonlinearly by 1.03 points (36.3%) over the course of 62 days to an average score of 1.81. The mean decrease during the first thirty days was 0.67(23.6%). Subgroup analysis did not reveal any influence factors.

CONCLUSION

Pain levels during the distraction phase are overall low, continuously decreasing, and well manageable with mostly non-opioid analgesics.