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A compartment syndrome developed in eleven patients who had undergone the Hauser procedure. The residual disabilities ranged from mild weakness and contracture of the muscles in the anterior compartment of the leg to complete muscle necrosis necessitating above-the knee amputation in two patients. Dissections of ten cadaver limbs demonstrated that the anterior tibial recurrent vessels have numberous leash-like branches that terminate along the lateral border of the tibial tubercle. When these vessels are sectioned they retract laterally and distally under the fascia and within the muscles of the anterior compartment. It is postulated that continued postoperative bleeding from these vessels after the Hauser procedure may lead to an ischemic compartment syndrome in the leg.
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PMID:Compartment syndrome as a complication of the Hauser procedure. 37 Jan 17

Twenty-five cases of anterior tibial-compartment syndrome in twenty-four patients were seen as complications of fractures of the shaft of the tibia. Six patients had fasciotomy within the first six hours of the onset of their symptoms and signs and all made an uneventful recovery. Eighteen patients, in whom treatment was withheld for an average of eighteen hours, were left with a variety of complications including persistent weakness of dorsiflexion in fourteen, a complete footdrop in three, and the necessity for a below-the-knee amputation in one.
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PMID:Anterior tibial-compartment syndrome complicating fractures of the shaft of the tibia. 127 Apr 75

Two patients sustained a severe compartment syndrome of the lower limb after surgery under bloodless field for 1 h 25 min and 43 min and with a tourniquet pressure of 350 and 450 mm Hg, respectively. In both cases fasciotomies were performed as an emergency procedure shortly after the initial operation. Renal failure was avoided but functional deficiencies, peroneal weakness, and restricted movements of the ankle resulted in both cases. We conclude that when using a tourniquet, any pre- and postoperative swelling or stiffness of the muscles in the operation area should be noted, even if the recommended time or pressure limits are not exceeded. Immediate fasciotomies of the affected compartments should be considered if the diagnosis is suspected.
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PMID:Compartment syndrome of the lower limb caused by a tourniquet: a report of two cases. 149 3

Young people active in sports, especially cyclists, runners and soccer players, may develop a chronic compartment syndrome, typically after a few years of athletic involvement. Complaints frequently appear when the intensity or frequency of training is increased. It is remarkable that runners develop mainly an anterior compartment syndrome, whereas soccer players and cyclists suffer mostly from a deep posterior compartment syndrome. The chief complaint is a cramp-like pain and weakness in the lower leg during effort. A compartmental tissue-pressure measurement must be performed to evaluate the severity of the compartment syndrome and to determine which compartments are involved. A clear clinical history and abnormal values of tissue-pressure measurements are indicative for a fascial release of the involved compartments and help assure a satisfactory result after surgery.
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PMID:Chronic compartment syndrome: diagnosis and management. 156 67

Anterior compartment syndrome of the thigh resulting from blunt contusion without an accompanying fracture is rare. The treatment advocated for it by most authors has been surgical. However, because wound infection rates are high and loss of knee range of motion is frequent, we considered conservative treatment in selected patients. Six athletes who developed an anterior thigh compartment syndrome shortly after sustaining a blunt contusion to the quadriceps with an accompanying massive hematoma were studied prospectively. Tissue pressure, renal function, and creatinine phosphokinase (CPK) levels were closely monitored. Fasciotomy was not performed, despite sustained pressure elevations above 50 mm Hg. Neurologic function was not affected. At follow-up examination 1 year later, no limitation of joint motion nor weakness of the quadriceps were observed. Thus in selected young patients in whom an isolated anterior compartment syndrome of the thigh occurs, conservative treatment yielded results superior to fasciotomy.
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PMID:Anterior compartment syndrome of the thigh in athletes--indications for conservative treatment. 174 Jul 99

Clinical diagnosis remains the most important factor in the diagnosis of compartment syndrome. Parameters such as swelling, pain result from passive stretching, sensory disturbances, motor weakness and pulse rate should be carefully analysed and recorded using a checklist. As a compartment syndrome can already occur after 2 h but often not until 6 days later, monitoring at short intervals is necessary during this time period. If the clinical diagnosis is not clear-cut and the possibilities of differential diagnosis have been exhausted, or if there is doubt concerning the extent of the increase in pressure, pressure should be measured to help establish the diagnosis.
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PMID:[Diagnosis of compartment syndrome]. 186 33

Compartment syndromes of the lower limb occur as an over-use type injury in athletes resulting in a chronic compartment syndrome. Alternatively they may occur as a result of trauma to the limb in the form of soft tissue injury or a closed fracture resulting in an acute compartment syndrome. Chronic compartment syndromes present as pain in the lower legs during exercise and are relieved after a variable period of rest. Diagnosis is aided by intracompartmental pressure monitoring during exercise and if symptoms have persisted for longer than 6 months treatment is by means of a subcutaneous fasciotomy. Acute compartment syndromes are relatively rare and often difficult to diagnose. If unrecognized they may lead to significant limb morbidity in the form of paraesthesia and muscle weakness. Diagnosis once again may be aided by intracompartmental pressure monitoring. Once the diagnosis has been made urgent surgical decompression in the form of an open fasciotomy is mandatory.
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PMID:Compartment syndromes of the lower limb. 207 98

Acute compartment syndrome of the thigh has been reported infrequently. To date, only eight cases from isolated blunt trauma without fracture have been reported. Two additional cases caused by intramuscular hematomas following blunt, low-energy trauma, which were treated successfully with emergency fasciotomies, are presented. The morbidity from this syndrome varies from mild, with quadriceps weakness, fatigue, and myositis ossificans, to severe, with limb-threatening vascular compromise. Morbidity can be avoided if a high level of suspicion is maintained, compartment pressures are measured, fasciotomies are performed, and hematomas are drained. Postoperatively, patients can expect a dramatic decrease in pain and a quick return of quadriceps function with aggressive physical rehabilitation.
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PMID:Acute anterior thigh compartment syndrome complicating quadriceps hematoma. Two case reports and review of the literature. 218 98

An effort-related compartmental syndrome is a condition in which increased pressure in a muscle compartment impedes blood flow and compromises metabolic demands of the tissues within that space. One can clinically distinguish acute irreversible and chronic reversible types. The aetiology relates in most instances to a limiting noncompliant fascia surrounding the affected muscle compartment. Sports activity leads to increased muscle volume and if there is a noncompliant fascia this will result in an excessive intracompartmental pressure which interferes with muscle blood flow. As a consequence of a reduced intracompartmental blood flow a reversible (recurrent) or irreversible (acute) exercise ischaemia, a so-called 'compartmental syndrome' occurs. A compartment syndrome is typically encountered in the lower leg, but it can be also observed in the upper leg and even in the forearm. Clinical history plays a key role in the diagnosis. Pain, muscle tightness and cramp-like feeling are the most common complaints. Weakness, paralysis and numbness are seen, especially in the acute syndrome. Symptoms appear at a certain intensity of activity and disappear at rest in the chronic compartment syndrome, but in the acute type pain will persist and will be severe. It is clearly an effort-related pain syndrome. Physical examination is not always useful in diagnosing a recurrent syndrome, but in the acute syndrome one will find high sensitivity to pressure and tenseness over the involved muscle compartment. Decreased or loss of active motion and sensation in the involved compartment are frequently seen. Tissue pressure monitoring can confirm the diagnosis for both types.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Acute and recurrent effort-related compartment syndrome in sports. 240 18

This case report documents an acute rupture of the lateral head of the gastrocnemius muscle at the myotendinous junction and a lateral dislocation of the tibialis anterior tendon with a clinical presentation consistent with a compartment syndrome, despite the intraoperative finding of a rupture of the posterior and lateral compartments. Extensive hematoma formation led to marked edema, paresthesias, muscle weakness, and severe pain in the involved leg. Surgical repair of the torn muscle and dislocated tendon and evacuation of the dissecting hematoma resulted in a well-functioning extremity. The authors emphasize the importance of prompt diagnosis of soft tissue injuries, which may place a patient at risk for a compartment syndrome. A compartment syndrome may lead to severe ischemia and irreversible tissue necrosis if intracompartmental hemorrhage of a torn muscle persists, and may require a surgical decompression. The clinical presentation, as well as adjunctive techniques in the diagnosis of a patient with a partial rupture of the gastrocnemius muscle, and a compartment syndrome, were presented.
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PMID:Rupture of the lateral head of the gastrocnemius muscle at the musculotendinous junction mimicking a compartment syndrome. 258 26


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