Thigh Compartment Syndrome, Presentation and Complications

Abstract

To describe the patient population, etiology, and complications associated with thigh compartment syndrome (TCS). TCS is a rare (0.3% of trauma patients) condition of elevated pressure within a constrained space that may cause necrosis of all tissues within the compartment resulting in severe local (infection, amputation) and systemic complications (renal insufficiency, even death). Retrospective cohort This study examines the course of treatment of nine consecutive patients with thigh compartment syndrome sustained during an eight-year period at our Level 1 trauma centre, admitting more than 2,000 trauma patients yearly.

Patients developing TCS were young (average 34.8 years) and likely to have a vascular injury on presentation (55.5%). A tense and edematous thigh was the most consistent clinical exam finding prompting the compartment release (77.8%). Average time from admission to the operating room was 19.8 ± 6 hours and 3/9 (33%) were noted to have ischemic muscle changes upon compartment releases. Complications ranging from infection to amputation developed in 4/9 (44.4%) patients.

TCS is associated with high energy trauma and it is difficult to diagnose in non-cooperative - obtunded and polytrauma patients. Vascular injuries are a common underlying cause and require prompt recognition and team work including surgical intensive care, interventional radiology, vascular and orthopaedic surgery in order to avoid severe medical and legal consequences.