Abstract
Bilateral acute compartment syndrome of the legs is a very rare presentation that requires emergency surgical intervention. Atraumatic bilateral cases are almost unheard of in medicine. There is currently no link between compartment syndrome and cognitive impairment or mental health.A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using the following keywords in multiple databases: compartment syndrome, atraumatic, spontaneous, bilateral, both, lower leg, acute, compartmental pressure, and fasciotomy. Atraumatic, bilateral, acute, and confirmed compartment syndrome cases were included.In total, 33 cases of atraumatic bilateral acute compartment syndrome (ABACS) were identified, of those 72.7% of cases were males. A form of cognitive impairment was found in 66% of cases. The medical history of the cases included substance abuse (nine patients), mental health illness (seven patients), and hypothyroidism (four patients). Within the reports, there was evidence of a misdiagnosis or delayed management in 19 cases (57.6%). Creatinine kinase (CK) was measured in 28 cases with a mean CK of 110,893 IU/L. Compartment pressure measurements were used in only 12 cases. A total of 29 cases were managed with bilateral four-compartment fasciotomy.This review highlights that ABACS is a condition with high rates of misdiagnosis or delay in treatment. Associations found included patients with cognitive impairment on presentation, mental health conditions, substance misuse, and elevated levels of CK. In addition, this review demonstrates that this condition is less rare than previously thought with serious morbidity and mortality.
Highlights
BackgroundAcute compartment syndrome is an orthopaedic emergency
Acute bilateral cases of compartment syndrome are a rare presentation outside the context of trauma or extreme exercise
We aimed to identify case reports or case series of patients who have had an episode of acute compartment syndrome that was atraumatic, in both lower legs, and diagnosed via fasciotomy, imaging, or pressure monitoring
Summary
Acute compartment syndrome is an orthopaedic emergency. If left untreated, it leads to limb ischemia and potentially devastating sequelae including permanent nerve damage and disability, amputation, and death [1,2]. The most common causes of acute compartment syndrome are fractures (open/closed), soft tissue injury, rhabdomyolysis, and vascular impairment. Burns, immobility, and infectious myositis can be causes [1,3]. Acute bilateral cases of compartment syndrome are a rare presentation outside the context of trauma or extreme exercise. They can be diagnostically challenging and may be underrecognised, leading to delayed diagnosis and poor outcomes [2]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
