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The Acute Compartment Syndrome of the Lower Leg: A Difficult Diagnosis?

February 9, 2021

Clinical Cases

The time to diagnosis of compartment syndrome and the time to proper treatment can determine the ultimate outcome for the patient. Though diagnosis can be difficult, it should be treated as a surgical emergency and assessed immediately.

Abstract

This case looks at three patients who developed acute compartment syndrome of the lower leg. Their diagnoses were delayed, and they developed severe complications. Two had transfemoral amputations, while the youngest patient’s leg was saved after extensive reconstructive surgery. The eventual outcome of compartment syndrome is directly related to the time elapsed between diagnosis and definitive treatment. Delays in treatment should be avoided at all costs.

Brief Case Description

If Acute Compartment Syndrome (ACS) of the lower leg is not recognized and/or left untreated, it can lead to the loss of the affected extremity. In severe cases, ACS is a life-threatening condition. The prognosis of full recovery is strongly dependent on an early diagnosis and treatment. Without it, the risks of complications and severity of the prognosis increases.

This publication looks at three complicated courses of ACS of the lower leg following trauma and gives a review of the diagnostic possibilities to try and recognize compartment syndrome in its early phases. They emphasize an understanding of the patient history, particularly with as much information about the injury, the degree of pain, and the time course. Then, a thorough physical examination where the primary finding may be swelling of the affected extremity in addition to the inability to actively move flexors and extensors of the foot. Beyond this, measuring intra-compartmental pressure (or, even better, the delta pressure) can offer a solution to aid in diagnosis and advisement of treatment.

Intervention and Outcome Summary

The elapsed time between the onset of a case of compartment syndrome and the treatment can determine the ultimate outcome for the patient. Therefore, the projected goal is to make this timeframe as short as possible. It’s critical to be alert for symptoms that can point to the early phases of compartment syndrome and assess immediately.

Original Publication

NCBI

Authors

P.P. Oprel, M.G. Eversdijk, J. Vlot, W.E. Tuinebreijer, and D. den Hartog

 
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