Acute compartment syndrome in the thigh complicating fracture of the femur. A report of three cases.

Acute Compartment Syndrome of the Thigh with Sciatic Nerve Palsy after Femoral Fractures

“…Most of the compartment syndromes of the thigh reported in the literature occurred in association with a fracture of the ipsilateral femur [1,3,10,14,16,19], as also demonstrated in our 3 cases. Other authors noted the development of compartment syndromes after contusion of the thigh without fracture [1,5,9,13,20].…”

“…Compartment pressures in the thigh ranged from 23 to 88 mm Hg in the reported cases in the literature [13,14,19]. In our patients compartment pressures ranged from 38 to 69 mm Hg.…”

“…In contrast to the lower leg, compartment syndromes of the thigh are rare. A large increase in volume is necessary to increase intracompartmental pressure in the thigh above a critical threshold [14,19]. In addition, the fascial compartments of the thigh blend anatomically with the muscles of the hip, providing a potential reservoir for decompressing fluid formations [14].…”

“…Other authors noted the development of compartment syndromes after contusion of the thigh without fracture [1,5,9,13,20]. Vascular injury and bleeding were further causes for reported compartment syndromes [9,14,19]. Tourniquet application to the thigh was also implicated with the development of a compartment syndrome [10,15].…”

Quadriceps Compartment Syndrome from Minor Trauma

“…1 Mubarak and Hargens advocate a limit for fasciotomy of 30 mm Hg, 1 whereas Matsen uses a pressure of 45 mm Hg as the lowest for which surgical decompression is warranted. 2 Acute compartment syndrome (ACS) involving the anterior thigh has been reported from myriad causes, including: severe crush injuries, femoral fractures, 3 military antishock trousers (MAST) application, 4 overexertion, 5 and contusion without fracture. 6 Acute quadriceps compartment syndrome (AQCS) secondary to minor blunt trauma has been reported in the literature of other specialties, [6][7][8] and ACS after minor trauma to other compartments has been reported in the emergency medicine (EM) literature.…”