U.S. military experience from 2001 to 2010 with extremity fasciotomy in war surgery

Abstract

After trauma, compartment syndrome of the extremities is a common, disabling, and—if managed suboptimally—lethal problem. Its treatment by surgical fasciotomy continues to be useful but controversial. The purpose of this survey is to measure survival and fasciotomy in a large trauma system to characterize trends and to determine if fasciotomy is associated with improved survival. Methods: We retrospectively surveyed data from a military trauma registry for U.S. casualties from 2001 to 2010. Casualties had extremity injury or extremity fasciotomy. We associated survival and fasciotomy. Results: Of 17,166 casualties in the total study, 19% (3,313) had fasciotomy and 2.8% (481) had compartment syndrome. Annual fasciotomy rates started at 0% (2001) and rose to 26% (2010). For all casualties, the survival rate initially was high (100%) but decreased steadily until its nadir (96.4%) in 2005. Thereafter, it increased to make a V-shaped trend with reversal occurring after fielding two interventions within the trauma system specifically for casualties at risk for fasciotomy—tourniquet use and a fasciotomy education program. Conclusions: Over a decade of war, the survival rate of extremity injured casualties was associated with two trauma system interventions—tourniquet usage and a fasciotomy education program. The current example of measuring implementation of initiatives may be useful as a model for future attempted improvements in health care.