Prevention of ischemicdisorders of the shin

Ischemic disorders of the shin are associated in most cases with the occurrence of local hypertensive ischemic syndrome. This syndrome, of mild to moderate severity, is quite difficult to diagnose, as it is masked by the clinical symptoms of the injury, but later characteristic complications may appear in the early period – infection of wounds, and later in the form of scar-fibrous tissue degeneration, delayed or non-healing of the fracture. The aim of the study was to determine the need for preventive fasciotomy in four shin cases during blocking intramedullary osteosynthesis in patients with fractured tibial diaphysis. In our studies, 93 patients with tibial diaphysis fractures were observed, 45 of them underwent semi-closed preventive fasciotomies from standard approaches for implantation of metal structures. We carried out monitoring of tissue pressure using the “Stryker” device. The pressure was determined at the following stages: before surgery, immediately after redrilling the bone marrow canal, after implantation of the metal structure, after fasciotomy followed by suturing the skin, 24 hours after surgery. During metallosteosynthesis of the tibia, a clinically significant increase in subfascial pressure is noted in the anterolateral and lateral compartments of the tibia. There is a slight change in subfascial pressure in the posterior surface and posterior deep compartments.

1. Strafun SS, Tkach AV, Dvorsky AG, et al. Algorithm of earlydiagnosis and tactics of treatment of compartment syn-drome. Disaster Medicine. 2015;1(89):34–39 (In Russ.).

2. Kezlya OP, Givoyno LV. Acute compartment syndrome as acomplication of tibial fractures. Novosti khirurgii.2010;4:146–156. (In Belarus.) https://elibrary.ru/paajuz

3. Plotkin AV, Tkach AV, Fedulichev PN, Dvorsky AG. Tech-nology of treatment of local hypertension-ischemic syndrome in lower leg injury. Disaster medicine. 2016;3(95):32–35. (InRuss.) https://elibrary.ru/wmgqyj

4. Simon R.R., Koenigsknecht S.D. Emergency orthopedics.Limbs. M.: Medicine; 1998. 624 p. (In Russ.)

5. Folkman's ischemic contracture. MedUniver clinic and treat-ment. Available from: https://meduniver.com/Medi-cal/travmi/ishemicheskaia_kontraktura_folkmana.htm [cited February 28, 2026].

6. Strafun S.S., Tkach A.V., Fedulichev P.N., Plotkin A.V. Sanatorium treatment of patients with compartment syndrome.Bulletin of Physiotherapy and Balneology. 2015;21(2):157.(In Russ.).

7. Nechaev EA, Revskoy AK, Savitsky GG. Crush Syndrome.Moscow: Medicine; 1993. 208 p. (In Russ.)

8. Tkach AV, Plotkin AV. Structural changes in skeletal muscles in local hypertensive ischemic syndrome. Morphology.2018;153(1):49–54. (In Russ.) https://doi.org/10.17816/morph.398190

9. Brooks B. Pathologic changes in muscle as a result of disturbances of circulation: an experimental study of Volkmann's is-chemic paralysis. Arch. Surg. 1922;51:18–216.

10. Tihonenko AA (jr), Tkach AV, Tihonenko AA, et al. Methodsof prevention of a compartment syndrome in closed lockableintramedullary osteosynthesis of tibia. Tavrich medical andbiological bulletin. 2022;25(1);50–54. (In Russ.) https://doi.org/10.37279/2070-8092-2022-25-1-50-54,https://elibrary.ru/ttsqvo

11. Tkach AV, Tikhonenko AA, Andrianov MV. Prevention andtreatment of compartment syndrome during closed lockableintramedullary osteosynthesis of shin bones. Bulletin ofphysio- and resort therapy. 2020;26(3):31–37. (In Russ.) https://doi.org/10.37279/2413-0478-2020-26-3-31-37,https://elibrary.ru/mjlzpy

12. Revskoy AK, Lyufing AA, Nikolenko VK. Gunshot wounds of the extremities: a guide for physicians. Moscow: Medicine; 2007. 272 p. (In Russ.)

13. Tyhonenko AA, Tkach AV. Dynamics of changes of creatine kinase during blocked intramedullary osteosynthesis of the tibia. Medical and pharmaceutical journal "Pulse". 2024;26(6):108–112. (In Russ.) http://dx.doi.org//10.26787/nydha-2686-6838-2024-26-6-108-112