Issn Print: 1098-7339

Publication Date: 2004/09/01


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Compartment syndrome: don't forget patient's position risks even though in a traumatic context: 43.

T Ferrant; R Fuzier; F Singelyn

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Excerpt

Compartment syndrome is frequently associated with lower limb trauma. Patient position during surgery is another well-known factor but often underestimated because of diagnostic difficulties. We report a case of a young patient who developed, few hours after an emergency femoral surgery, a compartment syndrome on the opposite limb.
A 20-yr old male (80 kgs, 185 cm) underwent an emergency surgery under general anesthesia for right femur and wrist fractures after a high velocity accident. Laying in spine position, the opposite lower limb was elevated in a hemilithotomy position. The surgery lasted 270 minutes. At the end of the procedure, the patient complained no pain and an ACP morphine started for pain relief. Six hours later, the patient complained of a light pain in the left calf with no other symptom. During the six following hours, the pain increased and the compartment became swollen and tense on palpation. Paresis of the common peroneal nerve occurred and signs of ischemia appeared. Peripheral pulses remained present. Pressure of the three compartments up to 100 mmHg confirmed the diagnostic of compartment syndrome. A fasciotomy of the lateral, medial and anterior compartments of the leg was performed resulting in an immediate revascularization of leg and foot. Ten days later, skin incisions were closed using a split skin graft for the medial side of the leg. After one month of follow-up, a paresis still limited dorsiflexion of the foot.
This case report highlights difficulties to diagnose compartment syndrome in lower limb not directly involved by trauma. Clinicians usually focus on limb directly involved by trauma. However, in case of long surgery duration, compartment syndrome risks increase. Compared to clinical symptoms, delay in diagnosis could be decreased when measures of compartment pressure are performed systematically, not only on the trauma limb but also after long duration in lithotomy position.

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