1/81. Spontaneous tibial compartment syndrome in Type 1 diabetes mellitus. We present a case of a patient with Type 1 diabetes mellitus (DM) who spontaneously developed severe bilateral anterior tibial compartment syndromes which required extensive surgical treatment. While infarction of skeletal muscle in Type 1 DM remains rare and usually affects the larger compartments of the thigh, this diagnosis must be entertained in any patient presenting with acute leg pain. If a patient displays any features of acute compartment syndrome, prompt fasciotomy must be undertaken. ( info) |
2/81. Chronic compartment syndrome of the lower leg: a new diagnostic method using near-infrared spectroscopy and a new technique of endoscopic fasciotomy. A 19-year-old female basketball player had chronic compartment syndrome. During basketball playing, she complained of bilateral lower leg pain that disappeared after several minutes of rest. The intracompartmental pressure in the anterior compartment was 41 mm Hg on the right side and 29 mm Hg on the left side immediately after playing. Prolonged ischemia of the anterior compartment was observed in comparison with four normal controls using near-infrared spectroscopy. magnetic resonance imaging also revealed that the anterior compartment was mainly affected. Endoscopic fasciotomy was performed using an arthroscope, a transparent outer tube, and a retrograde blade. After the operation, her symptoms disappeared. Three months postoperatively, the anterior compartment pressure decreased and prolonged tissue ischemia improved. Endoscopic fasciotomy allowed us to cut the fascia safely and less invasively. We concluded that this technique is useful in treating chronic compartment syndrome in the anterior compartment of the lower leg. ( info) |
3/81. Effort-related chronic compartment syndrome of the lower extremity. Effort-related chronic compartment syndrome (ERCCS) of the lower extremity is often misdiagnosed, requiring repeated visits to the physician and subsequent delay in definitive treatment. The most significant causes of chronic leg pain in physically active individuals are stress fractures, shin splints, and "exercise-induced" or effort-related chronic compartment syndrome. In patients susceptible to ERCCS, the fascial compartments are too small to accommodate the associated 20% increase in muscle mass that typically occurs with heavy exercise. The increased pressure within a small unyielding compartment limits circulation and subsequent muscle function. The only appropriate conservative treatment is cessation of the offending activity. Early suspicion of the condition is paramount, because the definitive treatment is fasciotomy. ERCCS has only recently been recognized, and therefore it may be underdiagnosed. family physicians and general medical officers caring for otherwise healthy soldiers and athletes should be aware of ERCCS so that prompt orthopedic referral for evaluation and definitive treatment will not be delayed. ( info) |
| A patient is presented who developed the Compartment Syndrome, following blunt trauma to the lower limb. A "fibulectomy-fasciotomy" was performed. This allowed restoration of normal peripheral circulation of the limb but failed to prevent ischaemic necrosis developing in the anterior tibial, peroneal and posterior tibial compartments. compartment syndromes in the lower limb are discussed, with a view to their early recognition and management. ( info) |
5/81. Compartmental syndromes in which the skin is the limiting boundary. Following closed fasciotomy, skin may become the limiting boundary of extremity swelling. The resulting increase in pressure within the limb may threaten its survival. Realizing this potential complications, we reserve closed fasciotomy for those cases in which only moderate swelling is anticipated. Following this procedure the patient is observed closely for evidence that decompression dermotomy is indicated. patients in whom severe swelling is present or anticipated are treated with fasciotomy and primary dermotomy. Wounds are closed by either primary or delayed skin graft. This approach has proven useful in the management of traumatized or vascularly embarrassed limbs in which swelling may compromise extremity viability. ( info) |
6/81. Acute exertional compartment syndrome in an athlete. Acute exertional compartment syndrome is a rare condition, associated with strenuous, unaccustomed exercise. This report describes its onset in a professional footballer during a regular training session. It is often diagnosed late due to lack of awareness and patient stoicism. We illustrate the consequences of delay and reinforce the need for prompt and decisive fasciotomy if complications are to be avoided. ( info) |
7/81. Multifocal streptococcal pyomyositis complicated by acute compartment syndrome: case report. A 5-year-old girl sought treatment for pyrexia of unknown origin. Despite prompt surgical drainage of a streptococcal septic arthritis of the ankle joint, her condition deteriorated. Multifocal pyomyositis was subsequently diagnosed. This was complicated by acute compartment syndrome in three extremities. With aggressive surgical and medical management, the child made a complete recovery. Orthopaedic clinicians in nontropical areas must familiarize themselves with this rare, potentially life-threatening, but eminently curable disease. ( info) |
8/81. Hyperbaric oxygen (HBO) as useful, adjunctive therapeutic modality in compartment syndrome. The authors describe a compartment syndrome progressively developed after a long-term surgical procedure, with a patient positioned in supine position with calf rest, who was successfully treated with hyperbaric oxygenation. This approach saved the patient from a more invasive therapeutic intervention. ( info) |
9/81. One-portal technique of endoscopic fasciotomy: Chronic compartment syndrome of the lower leg. Many athletes complain of exercise-induced pain in the lower leg that can be caused by inflammatory diseases, peripheral nervous system disease, fatigue fracture, shin splint, and chronic compartment syndrome (CCS). CCS is the most typical exercise-induced condition and it often requires surgical decompression of the several compartments. There are already many techniques reported in the literature. Recently, an endoscopic technique for CCS was reported with which excellent results were achieved. We have modified it and developed a new technique for treating CCS of the lower leg. We report a case of CCS of the lower leg treated with 1-portal endoscopic fasciotomy. The technique helps to decrease damage to soft tissue and patients will immediately return to normal activities of daily living. ( info) |
10/81. Compartment syndrome of the well leg as a result of the hemilithotomy position: a report of two cases and review of literature. Compartment syndrome in the well leg as a complication of prolonged positioning in a hemilithotomy position is a serious complication that is rarely reported in the orthopaedic literature. A similar entity has been well described in urologic, gynecologic, and general surgery literature but, to the authors' knowledge, has been reported in only seven patients in the orthopaedic literature. The authors report two cases of unilateral compartment syndrome in a well leg during femoral nailing of the contralateral leg. risk factors, theories of pathogenesis, and preventive measures are identified and discussed. ( info) |