Gluteal Compartment Syndrome Secondary to Pelvic Trauma

Abstract

Gluteal compartment syndrome (GCS) is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death.

A Pain in the Butt: A Case Series of Gluteal Compartment Syndrome

“…Most authors suggest an intracompartmental pressure of 30 mm Hg as the threshold for initiating treatment, but GCS is ultimately a clinical diagnosis. 11 Patients who are unable to give a reliable history or participate in an exam are even more difficult to diagnose.…”

Missed positional gluteal compartment syndrome in an obese patient after foot surgery: a case report

“…Gluteal compartment syndrome is a rare condition that mainly occurs after trauma directly to the gluteal area or prolonged immobilization with pressure on the gluteal region after intoxication or prolonged surgery [ 2 – 4 , 10 , 11 ]. Acute pelvic trauma can cause gluteal compartment syndrome due to local swelling from the injury that compromises vascular structures within a closed fascial space [ 1 , 11 , 12 ]. Postoperative gluteal compartment syndrome can occur due to local surgical trauma where structures have been incised and manipulated leading to edema; however, most cases of postoperative gluteal compartment syndrome affect the non-operative anatomical site due to prolonged immobilization and pressure.…”

“…Compartment syndrome in the gluteal area is a rare and often unrecognized syndrome. Trauma, vascular injury, infection, surgical positioning, and prolonged immobilization from drug or alcohol intoxication are the most common causes of gluteal compartment syndrome [ 1 – 4 ]. Early recognition and treatment can help to prevent long term complications such as residual sciatic nerve problems or renal failure from rhabdomyolysis [ 5 , 6 ].…”

Gluteal compartment syndrome following alcohol intoxication: Case report and literature review

“…The pressure was not measured in the present patient due to historical and clinical evidence highly suggestive of gluteal CS. Clinical findings such as increased levels of creatinine phosphokinase and increased creatinine, coupled with historical components of drug abuse and paresthesia, were sufficient diagnose this patient with gluteal CS [14]. Measurement of compartment pressures can be done on patients who are unconscious and whose clinical and historical components cannot be appropriately assessed.…”

“…Measurement of compartment pressures can be done on patients who are unconscious and whose clinical and historical components cannot be appropriately assessed. Prior studies have reported the time-sensitive treatment of ischemia such that six-eight hours of muscle ischemia is often irreversible [14] .…”