The document describes the procedure for performing a fasciotomy to treat compartment syndrome in a patient with a tibia fracture. It details making an incision anterior to the fibula to access the anterior and lateral compartment fascia. The anterior compartment fascia is released first, taking care to avoid damaging the superficial peroneal nerve. The lateral compartment fascia is then released, being aware the peroneal nerve can cross through in some cases. Releasing the fascia of the anterior and lateral compartments provides treatment for the compartment syndrome.

2. AP and lateral radiographs of a young man with a segmental tibia fracture.

3. Clinical appearance of the extremity approximately one hour after the injury.
The compartment pressures in the anterior and lateral compartment
were equal to the diastolic pressure and in the posterior compartments were
40mm less than diastolic pressure.

4. INCISION
Location of incision, which should be just anterior to the fibula.

5. After the skin and subcutaneous tissue is incised, care is taken
to spread and cut only which is visible above the fascia.

6. ANTERIOR
COMPARTMENT FASCIA
After release of the subcutaneous tissue,
the anterior compartment fascia is released.

8. EDGES OF RELEASED ANTERIOR
COMPARTMENT FASCIA
The stripping above the anterior compartment fascia visualized here
was from the injury and not from surgical dissection. Note the wide
subcutaneous degloving injury.

9. EDGES OF RELEASED ANTERIOR
COMPARTMENT FASCIA
Care must be taken when releasing the fascia not to damage the
superficial peroneal nerve.

10. SUPERFICIAL PERONEAL NERVE
This figure demonstrates the superficial peroneal nerve running
immediately adjacent to the fascia in the proximal part of the wound…

11. SUPERFICIAL PERONEAL NERVE
…and in the distal part of the wound.

12. FASCIA OF LATERAL
COMPARTMENT
Retraction of the superficial tissue demonstrates
the lateral compartment fascia.

13. FASCIA OF LATERAL
COMPARTMENT
Because the peroneal nerve can cross through the intermuscular septum
in 25% of cases, it is important that the lateral compartment musculature
be released from its outer fascia, not through the intermuscular septum.

14. A knife or Metzenbaum scissors can be used to
release the lateral compartment fascia.

15. Appearance after anterior and lateral compartment release.

16. SUPERFICIAL POSTERIOR
COMPARTMENT
Although unnecessary in this case, anterior retraction of the lateral
compartment exposes the superficial posterior compartment fascia,
which can be released.

17. SUPERFICIAL POSTERIOR
COMPARTMENT
Further dissection, as in the posterior lateral approach of Harman,
allows for release of the deep posterior fascia through this incision
as well.

18. AP and lateral views of the patient after intramedullary nailing is
performed. Intramedullary fixation is the treatment of choice in a
patient who is treated with fasciotomy for compartment syndrome.