Multiple stab incision technique to prevent postoperative acute compartment syndrome of leg in proximal and segmental fracture tibia and fibula: a prospective study


  • K. Parthasarathi Naik Department of Orthopedic, K. S. Hospital Koppal, Karnataka, India
  • Shankarlinga S. Department of Orthopedic, K. S. Hospital Koppal, Karnataka, India
  • Basavaraj S. Kyavater Department of Orthopedic, K. S. Hospital Koppal, Karnataka, India
  • Prashanthkumar M. Department of Orthopedic, K. S. Hospital Koppal, Karnataka, India



Multiple stab incision technique, ACS, Both bones (tibia and fibula)


The objective is to study the effectiveness of Multiple stab incision technique in preventing acute compartment syndrome (ACS) in proximal and segmental fractures of both bones (Tibia and fibula) in leg. This study is prospective done at K. S. Hospital Koppal, Karnataka spanning for a period of one year (April 2020 to April 2021). A total of 20 patients of both genders aged 20-60 years were included in the study. Multiple stab incision technique was performed in patients after fixation of Tibia by either closed nailing or MIPPO plating. This procedure was done under spinal anesthesia. Multiple stab incision technique significantly decreased the chances of post-op ACS in proximal and segmental fractures of both bones (tibia and fibula) in leg. Multiple stab incision technique is help full in preventing developing compartment syndrome.




DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. 1981;(160):175-84.

McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996;78(1):95-8.

Blick SS, Brumback RJ, Poka A. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1986;68(9):1348-53.

Ouellette EA. Compartment syndrome in obtunded patients. Hand Clin. 1998;14(3):431-50.

Har-Shai Y, Silbermann M, Reis ND. Muscle microcirculatory impairment following acute compartment syndrome in the dog. Plast Reconstr Surg. 1992;89(2):283-9.

Shadgan B, Menon M, O’Brien PJ, Reid WD. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma 2008;22(8):581-7.

Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg. 1976;58(1):112-5.

Rorabeck CH. The treatment of compartment syndromes of the leg. J Bone Joint Surg Br. 1984;66(1):93-7.

Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma. 2004;18(4):220-4.

Cox G, Thambapillay S, Templeton PA. Compartment syndrome with an isolated Salter Harris II fracture of the distal tibia. J Orthop Trauma. 2008;22(2):148-50.

Patillo D, Della Rocca GJ, Murtha YM, Crist BD. Pilon fracture complicated by compartment syndrome: a case report. J Orthop Trauma. 2010;24(6):54-7.

Gross RH, Cook M, Barfield WR. Codetron as adjunctive treatment in pediatric patients following spinal surgery. J S C Med Assoc. 2007:103(7):182-4.

Eaton RG, Green WT. Volkmann’s ischemia. A volar compartment syndrome of the forearm. Clin Orthop Relat Res. 1975;(113):58-64.

Matsen FA 3rd, Krugmire RB Jr. Compartmental syndromes. Surg Gynecol Obstet. 1978;147(6):943-9.

Ernest CB, Brennaman BH, Haimovici H. Fasciotomia. In: Haimovici H, Ascer E, Hollier LH, Strandness DE Jr, Towne JB, editors. Cirurgia vascular: princípios e técnicas. 4th ed. Di-Livros; São Paulo. 2000;1290-8.

Pitta GBB. Lesiones de la arteria poplitea por traumatismo en la vida civil. Anais do XVIII Congresso Del Capitulo Latino Americano. II Congresso Nacional de Angiologia; Punta Del Leste. 1986;76.

Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975;(113):43-51.

Holden CE. The pathology and prevention of Volkmann’s ischaemic contracture. J Bone Joint Surg Br. 1979;61(3):296-300.

Rorabeck CH, Castle GS, Hardie R, Logan J. Compartment pressure mesurements: an experimental investigation using the slit catheter. J Trauma. 1981;21(6):446-9.

Mubarak SJ, Hargens AR, Owen CA. The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool. J Bone Joint Surg Am. 1976;58(7):1016-20.

McQueen MM. How to monitor compartment pressures. Tech Orthop. 1996;11(1):99-101.

Prayson MJ, Chen JL, Hampers D. Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome. J Trauma. 2006;60(5):1037-40.

Vrouenraets BC, Kroon BB, Klasse JM. Value of laboratory tests in monitoring acute regional toxicity after isolated limb perfusion. Ann Surg Oncol. 1997;4(1):88-94.

Sorichter S, Mair J, Koller A. Early assessment of exercise induced skeletal muscle injury using plasma fatty acid binding protein. Br J Sports Med. 1998;32(2):121-4.

van Nieuwenhoven FA, Kleine AH, Wodzig WH. Discrimination between myocardial and skeletal muscle injury by assessment of the plasma ratio of myoglobin over fatty acid-binding protein. Circulation. 1995;92(10):2848-54.

Shuler MS, Reisman WM, Kinsey TL. Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg. J Bone Joint Surg Am. 2010;92(4):863-70.

van den Brand JG, Nelson T, Verleisdonk EJ, van der Werken C. The diagnostic value of intracompartmental pressure measurement resonance imaging, and near-infrared spectroscopy in chronic exercise compartment syndrome: a prospective study in 50 patients. Am J Sports Med. 2005;33(5):699-704.

Garr JL, Gentilello LM, Cole PA. Monitoring for compartmental syndrome using near-infrared spectroscopy: a noninvasive continuous transcutaneous monitoring technique. J Trauma. 1999;46(4):613-8.

Mullet H, Al-Abed K, Prasad CVR, O’Sullivan M. Outcome of compartment syndrome following intramedullary nailing of tibial diaphyseal fractures. Int J Care Injured. 32(5):P347-32.

Pitta GBB, Dos Santos TFA, Dos Santos FTA, Da Costa Filho EM. Compartment syndrome after tibial plateau fracture. Rbo Rev Bras Ortop. 2014;49(1);86-8.