RESEARCH ARTICLE


The Acute Compartment Syndrome of the Lower Leg: A Difficult Diagnosis?



P.P Oprel1, M.G Eversdijk1, J Vlot2, W.E Tuinebreijer1, D den Hartog*, 1
Department of 1 Surgery-Traumatology University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
Department of 2 Pediatric Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands


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Creative Commons License
© Oprel et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, ‘s Gravendijkwal 230, Office H-960, 3015 CE Rotterdam, The Netherlands; Tel: +31 10 7032395; Fax: +31 10 7032396; E-mail: d.denhartog@erasmusmc.nl


Abstract

Three patients, two adults and one child, developed an acute compartment syndrome of the lower leg. Due to delay in diagnosis, severe complications developed, resulting in two transfemoral amputations. In the youngest patient, the lower leg was able to be saved after extensive reconstructive surgery. In most cases, acute compartment syndrome of the lower leg is seen in combination with a fracture (40%), although other causes (minor trauma or vascular surgery) are also known. Moreover, patient history (pain out of proportion to the associated injury) and physical examination are central to the diagnosis. In some cases, however, a reliable diagnosis cannot be made clinically, as in the case of unconscious, intoxicated or intubated patients, as well as small children. Under these circumstances, intra-ompartmental pressure measurement can be of great assistance. After confirmation of the diagnosis, immediate fasciotomy of all lower leg compartments should be performed. The eventual outcome of this syndrome is directly related to the time elapsed between diagnosis and definitive treatment. Although the diagnosis can be difficult, delays in treatment should be avoided at all costs. The acute compartment syndrome of the lower leg is a surgical emergency and should be dealt with immediately.

Keywords: Compartment syndrome, bone fracture, leg.