THE EFFECT OF EARLY VERSUS LATE FASCIOTOMY IN THE MANAGEMENT OF EXTREMITY TRAUMA

Background. Recent reports have demonstrated an increase in the number of complications associated with delayed timing of fasciotomy for tra uma. This study examines the effectiveness of early (less than 12 hour s) versus late (more than 12 hours)fasciotomy in the injured extremity . Methods. This is a retrospective review of 88 patients undergoing fa sciotomy for extremity trauma admitted to the University of Cincinnati from January 1990 through December 1995. Records were reviewed for de mographics, compartment pressures, time and type of fasciotomy, compli cations, limb salvage, and mortality. Statistical analysis was determi ned with chi-squared, multivariant regression analysis, and Student's t test with significance at p less than 0.05. Results. Sixty-one (69%) patients had fasciotomy performed before 12 hours and twenty-seven (3 1%) after 12 hours. Although the rates of infection differed significa ntly between the two groups (7.3% for early versus 28% for late), the rates of limb salvage and neurologic sequelae were similar. Age, mecha nism, shock associated injuries, and time to fasciotomy were not predi ctive of complications. Conclusions. Fasciotomy for trauma is most eff icacious when performed early. However, when performed late, it result s in similar rates of limb salvage as compared with early fasciotomy b ut at the increased msk of infection. These results support aggressive use of fasciotomy in extremity trauma regardless of time of diagnosis .