Acute leg compartment syndrome after exertion

Abstract

A case of a 22-year old soldier, with a history of pain in the leg during heavy exercise, which desisted at rest, was presented. One day before admission, the patient had felt an extreme exertion-induced pain in his right leg which had not lessenned at rest. At the same time, the patient noticed persistent severe leg edema. On physical examination, the intracompartmental pressure was 62 mmHg (> 30 mmHg). The patient was urgently operated on, and fasciotomy according to Mubarak was used. At second surgery, the debridement of the muscles of the posterior group of the leg, and the evacuation of hemathoma from the anterior and lateral group of the right leg muscles were perfomed. Postoperative recovery was uneventful. Fasciotomy wounds were closed within 14 days of the surgery. The complete physical treatment was done. Follow-up examinations 1, 3, and 6 months afterwards were satisfactory. The soldier completed his compulsory military service without any sequelae. Laboratory results were normal. Overlooked, unrecognized or surgically untreated compartment syndrome can cause severe damage, including even the loss of the extremity.

Compartment syndrome of forearm and hand as complication of prone position during neurosurgery operation

“…CS is defined as a condition of elevated interstitial pressure inside closed osteofascial spaces with compromised microcirculation and ischemia of neuromuscular tissues. CS is frequently caused with prolonged ischemia with late revascularization, bone fractures with hematomas in muscle compartments, Crush syndrome, prolonged compression on extremities in unsual positions in unconscious drug abusers, extreme exercise, mannitol extravasation in an anesthetized patient, brachial artery cannulation, or prolonged operation in the prone position [1][2][3][4][5][6].…”

“…CS needs to be differentiated from injury to the artery, vein or nerves, bone fracture, muscle injury or soft tissue infections (phlegmon, thrombophlebitis and osteomyelitis). Although diminished pulse was in the past considered sign of CS, this actually never happens as ICP must exceed systolic arterial pressure [1][2][3]. Special consideration for CS diagnosis is needed in patients where clinical evaluation is difficult, such as in children, uncooperative patients, comatose or anesthetized patients, and patients with nerve deficits.…”

“…Compartment pressure exceeding 30 mmHg and lasting longer than six to eight hours are associated with neuromuscular tissue necrosis and chronic functional defects, including sensory deficit, motor weakness and contractures [7,8]. Unfortunately, limb amputation is inevitable if extensive muscle necrosis develops in cases where revascularization was delayed (after 12 hours of CS duration) [1][2][3].…”

“…Advantages of this technique include simplicity, no need for additional equipment, and feasibility in any intensive care unit or small hospital, so that there is no need for involvement of experienced surgeons [1][2][3]. ICP > 30 mmHg is indication for immediate decompression with fasciotomy.…”