Acute exertional compartment syndrome: A case series and review of the literature

Abstract

Acute compartment syndrome (ACS) is a devastating condition related to increased pressures within fascial compartments. Common etiologies include high energy trauma and extravasation or bleeding events. Rarely, walking or low impact, highly repetitive activities are implicated. In this paper we review 3 consecutive patients that presented with acute compartment syndrome after performing walking events during training in the United States Army. Two of these patients had myonecrosis of the anterior and lateral compartments, requiring posterior tibial tendon transfers. The final patient had no myonecrosis, but continued to have superior peroneal nerve irritation. We compare these patients to others with acute exertional compartment syndrome previously reported in the literature. Overall, patients with upper extremity, hand, foot and paraspinal acute exertional compartment syndrome have a good prognosis, while those with acute exertional compartment syndrome of the leg have a poor prognosis regardless of the timing of surgery.