Anterior compartment syndrome of the thigh in athletes–indications for conservative treatment.

Robinson D, On E, Halperin N. J Trauma 1992 Feb;32(2):183-6.

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.

Acute compartment syndrome.

Engelund D, Kjersgaard AG. Ugeskr Laeger 1991 Apr 15;153(16):1110-3.

The object of this article is to review the current knowledge about the acute compartment syndrome. The syndrome is caused by increased pressure in a muscle compartment and may result from several different conditions: fractures, contusions, haemorrhage, poisoning etc. The pathological physiology is complicated but the main theory is that progressive venous hypertension is involved and that this causes cessation of the microcirculation of the muscle concerned. The clinical diagnosis is described and pressure recording apparatus is reviewed. Treatment of the acute compartment syndrome consists of fasciotomy. Common sites are indicated and operative techniques suggested. Fasciotomy should be performed with compartmental pressures of about 30 mmHg. The untreated compartment syndrome will result in muscular fibrosis and nerve injury and will thus cause incapacitating conditions which may be avoided entirely if fasciotomy is performed in time.

Thigh compartment syndrome in a football athlete: a case report and review of the literature.

Colosimo AJ, Ireland ML. Department of Orthopaedic Surgery, University of Cincinnati, OH 45219.

Although contusions of the thigh are common in all sports, a compartment syndrome from closed blunt trauma without a femur fracture is rare. Thigh compartment syndrome is unusual due to increased compliance of the thigh to accommodate increased expansion from hematoma or third space fluid. Compartment syndrome of the thigh is characterized by unrelenting pain, swelling, and limited knee range of motion. A single case of a thigh compartment syndrome caused by a direct blow to the anterior aspect of the thigh from a football helmet during kickoff occurred. Immediate thigh fasciotomy was performed. Early diagnosis with appropriate emergency treatment can avoid serious and permanent complications.