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Diagnosis and Management of Chronic Exertional Compartment Syndrome (CECS) in the United Kingdom

Tzortziou, Victoria MD, MRCGP, MSc*; Maffulli, Nicola MD, MS, PhD; Padhiar, Nat MSc, PhD

Clinical Journal of Sport Medicine: May 2006 - Volume 16 - Issue 3 - p 209-213
Original Research
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Objective To investigate current practice in the diagnosis and management of chronic exertional compartment syndrome (CECS) of the lower leg among orthopedic surgeons in the United Kingdom.

Design Questionnaire survey.

Setting Secondary care (NHS and private).

Participants Two hundred six orthopedic surgeons affiliated with one of the following specialist associations: British Association of Sports and Exercise Medicine (BASEM), United Kingdom Association of Doctors in Sport (UKADIS), British Orthopedic Sports and Trauma Association (BOSTA) and British Orthopedic Foot Surgery Society (BOFSS).

Interventions Self-administered questionnaire.

Main Outcome Measures Current practice in diagnosis and treatment of CECS.

Results Sixty percent (124/206) of the surveyed population replied and 53% (66/124) see patients with CECS. To confirm the diagnosis, 83% (55/66) use intra-compartmental pressure measurements (ICPs). Of these, 42% use maximal ICP during exercise greater than 35 mmHg as a criterion for anterior CECS diagnosis and 35% use Pedowitz's modified criteria. Of all the respondents, 88% would be willing to adopt a National Framework document for diagnosis, 30% (20/66) always try conservative treatment following diagnosis, 93% (57/60) perform superficial fasciotomy as the first line surgical procedure, 55% (33/60) use a one incision technique for anterior fasciotomy and 60% (36/60) undertake a repeat fasciotomy following failed decompression.

Conclusions There is agreement among orthopedic surgeons on the role of ICPs for diagnosis and the choice of fasciotomy as a first-line surgical procedure. In contrast, there is a divergence of opinions regarding the ICP diagnostic thresholds, the role of conservative management and the surgical techniques for fasciotomy and failure of decompression.

*Academic Department of Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, The Royal London Hospital (Mile End), London

Trauma and Orthopaedic Surgery, Keele University School of Medicine, Thornburrow Drive, Hartshill, Stoke on Trent, Staffs

The Royal London Hospital Rheumatology and Sports Medicine Department, Surgical and Anaesthetic Directorate, Bancroft Road, Mile Ene, London

Reprints: Dr Victoria Tzortziou, Flat 902, Landmark Heights, 172 Daubeney Road, London E5 0EN, United Kingdom (e-mail: victoriagiorgio@yahoo.co.uk).

Received for publication December 2005; accepted February 2006

© 2006 Lippincott Williams & Wilkins, Inc.