Late reconstruction for sequelae of compartment syndrome

Compartment syndrome can have devastating consequences including severe deformity, chronic pain, paralysis, and even amputation. The best treatment is immediate fasciotomies and prevention of late contractures from occurring. If they do occur, a variety of deformities can develop depending on the most fibrotic and ischemic muscles. Although the anterior and lateral compartments are the most commonly involved in compartment syndrome, it is the muscles of the deep posterior compartment (flexor digitorum longus, flexor hallucis longus, and tibialis posterior) that determine the equinovarus deformity of the foot that is most commonly seen. Treatment of the sequelae of compartment syndrome is tailored to treat the various deformities that an individual patient has. Percutaneous Achilles tendon lengthening, gastrocnemius recession, or toe tenotomies are commonly used in the early phase. As deformity progresses, excision of fibrotic muscles (to prevent recurrence) combined with open Achilles lengthening, flexor tendon releases, or posterior ankle capsular releases may become necessary. Finally, in the late stages of disease with fixed claw tow contractures, especially with painful arthritis, the patient may require arthrodesis with wedge resection at the level of the joint or joints being arthrodesed.