Research
Acute morbidity and complications of thigh compartment syndrome: A report of 26 cases
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* Corresponding author: Enes M Kanlic Enes.Kanlic@ttuhsc.edu
1 Department of Orthopaedic Surgery and Rehabilitation at TTUHSC in El Paso, Texas 4801 Alberta Ave., El Paso, Texas 79905, USA
2 Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
3 Department of Orthopaedic Surgery and Rehabilitation at TTUHSC in El Paso, Texas 4801 Alberta Ave., El Paso, Texas 79905, USA
4 Department of Orthopaedic Surgery and Rehabilitation at TTUHSC in Lubbock, Texas, USA
5 Department of Orthopaedic Surgery, Geisinger Clinic, 100N. Academy Ave, Danville, PA 17822, USA
Patient Safety in Surgery 2010, 4:13 doi:10.1186/1754-9493-4-13
Published: 19 August 2010Abstract
Background
To describe the patient population, etiology, and complications associated with thigh compartment syndrome (TCS). TCS is a rare condition, affecting less than 0.3% of trauma patients, caused by elevated pressure within a constrained fascial space which can result in tissue necrosis, fibrosis, and physical impairment in addition to other complications. Compartment releases performed after irreversible tissue ischemia has developed can lead to severe infection, amputation, and systemic complications including renal insufficiency and death.
Methods
This study examines the course of treatment of 23 consecutive patients with 26 thigh compartment syndromes sustained during an eight-year period at two Level 1 trauma centers, each admitting more than 2,000 trauma patients yearly.
Results
Patients developing TCS were young (average 35.4 years) and likely to have a vascular injury on presentation (57.7%). A tense and edematous thigh was the most consistent clinical exam finding leading to compartment release (69.5%). Average time from admission to the operating room was 18 +/- 4.3 hours and 8/23 (34.8%) were noted to have ischemic muscle changes at the time of release. Half of those patients (4/8) developed local complications requiring limb amputations.
Conclusion
TCS is often associated with high energy trauma and is difficult to diagnose in uncooperative, obtunded and multiply injured patients. Vascular injuries are a common underlying cause and require prompt recognition and a multidisciplinary approach including the trauma and orthopaedic surgeons, intensive care team, vascular surgery and interventional radiology. Prompt recognition and treatment of TCS are paramount to avoid the catastrophic acute and long term morbidities.