Acute compartment syndrome of the thigh: diagnosis and management
Alexis S. Chiang, Nirmal C. Tejwani
Department of Orthopedic Surgery, The New York University Hospital for Joint Diseases
Keywords: Compartment syndromes/diagnosis/surgery; fascia/ surgery; thigh/surgery.
Objectives: The purpose of this study was to review our experience with compartment syndrome (CS) of the thigh and to provide guidelines for its management.
Patients and methods: The study included 10 cases of thigh CS in seven male patients (mean age 26 years; range 17 to 47 years). The mechanisms of injury included trauma due to a motor vehicle accident, sports injuries (n=2), blunt trauma, crush injuries (n=2), and after intramedullary nailing of a femur fracture. Four patients developed CS of the ipsilateral leg, of whom two also had CS of the ipsilateral foot. Three patients had bilateral CS of the thighs, two of whom also had bilateral CS of the legs. One patient had acute CS of the forearm. Decision for fasciotomy of the thigh was based on clinical evidence for tense compartments with elevated compartment pressures, increased need for analgesia, and pain with passive range of motion. All wounds were treated with delayed primary closure. The mean follow-up was one year (range 3 to 36 months).
Results: Associated morbidities included rhabdomyolysis in four patients, of which one progressed to acute renal failure. Three patients developed deep vein thrombosis. At fasciotomy, there was evidence for muscle necrosis in two patients. One patient had hematoma. One patient sustained an injury to the superficial femoral artery. The mean length of stay was 30 days (range 7 to 43 days). Upon discharge, five patients had intact neurovascular status. Two patients had a foot drop, one with bilateral, which did not resolve at three years’ follow-up. All patients underwent multiple debridements, ranging from 2 to 39 including definitive wound closure.
Conclusion: Emergent fasciotomy and release of affected compartments minimize morbidity and future complications.