<p>Well leg compartment syndrome in trauma surgery &ndash; femoral shaft fracture treated by femoral intramedullary nailing in the hemilithotomy position: case series and review of the literature</p>

Abstract

Well leg compartment syndrome (WLCS) is a rare complication which can occur following urological, gynecological, general surgical or orthopedic surgeries carried out with the lower limb in the hemilithotomy position. WLCS is associated with significant morbidity and mortality because delay in diagnosis and treatment can lead to loss of function and even life-threatening complications. During orthopedic surgeries on a traction table, such as femoral nailing, the contralateral “well leg” is often placed in the hemilithotomy position, thus facilitating the use of fluoroscopy. This position (also named the Lloyd-Davis position) consists of hip flexion, abduction, external rotation and knee flexion. We present the cases of two teenaged patients who underwent femoral nailing on an extension table of a femoral fracture and developed WLCS. We also present a review of the literature and a discussion of the pathophysiology, risk factors and treatment of this condition. Clinicians need to be aware of the risk factors for WLCS and have high index of suspicion. Further studies looking at the risks, benefits and feasibility of ways to reduce this risk are required.

Compensation claims in pediatric orthopedics in Norway between 2012 and 2018: a nationwide study of 487 patients

“…It is important to be aware of the risk of compartment syndrome of the contralateral side due to malpositioning (hemilithotomy position) during surgery for femoral fractures. This is an avoidable complication that has been described in the literature (Brouze et al 2019).…”

Well leg compartment syndrome due to the lithotomy position in orthopedic surgery: a report of two cases and a review of the literature

“…The surgical team needs to maintain a high level of suspicion for patients who are at a risk of developing WLCS. This is further optimised with the use of general anesthesia versus epidural anesthesia, which allows an earlier recognition of the syndrome [ 23 , 24 ].…”

Well Leg Compartment Syndrome after Contralateral Femoral Neck ORIF

“…However, other strategies can be utilized to facilitate intraoperative imaging. Brouze et al described securing the nonoperative leg to the traction bar of a fracture table with cushions [5]. Alternatively, the nonoperative leg can be prepped into the surgical field and a sterile drape applied to the well leg to allow for well leg positioning only during use of fluoroscopy.…”