Acute Compartment Syndrome of the Thigh with Sciatic Nerve Palsy after Femoral Fractures

Abstract

Acute compartment syndromes of the thigh are rare and have been infrequently reported in the literature. They occur with greatest frequency in association with femoral fractures. Patients who sustained multiple trauma have an increased susceptibility to the development of compartment syndrome of the thigh, and compartment syndromes are often overlooked in these cases. A compartment syndrome in a cooperative patient can be diagnosed clinically, but it presents a special challenge if the patient is multiply injured and unable to cooperate with the physical examination. Left unrecognized, compartment syndromes of the thigh can result in permanent damage to muscle and nerve in that compartment. Early diagnosis through a high index of suspicion and measurement of intracompartmental pressure in each compartment is mandatory. Intraoperative measurement of compartment pressure is recommended in cases of impending compartment syndrome. Immediate fasciotomy is indicated to provide the optimum chance of recovery and to prevent microvascular compromise and necrosis of tissue. We present 3 cases of multiply injured patients in which sciatic nerve palsy followed fracture of the ipsilateral femur und compartment syndrome of the thigh. We found that the extent of myoneural necrosis seems to be dependent on the duration and magnitude of the elevated compartment pressure. A comprehensive review of the literature about compartment syndromes of the thigh is also presented.