Bilateral Exercise-Induced Compartment Syndrome of the Thigh and Leg Associated with Massive Heterotopic Ossification: A Case Report

Abstract

Compartment syndrome of the thigh is an infrequent phenomenon, and it is even more rare for it to occur as a result of exercise. The vast majority of cases are associated with femoral fractures, thigh contusions, prolonged compression, and/or vascular injuries1,2. A search of the English-language literature revealed only eleven cases caused by intense or prolonged exercise (Table I). More importantly, we found only one reported case of bilateral thigh and leg compartment syndrome, the outcome of which was death secondary to multiorgan failure3. We are presenting what we believe is the first report on a survivor of exercise-induced compartment syndrome of both thighs and legs. Follow-up at fourteen months demonstrated reasonable functional recovery despite life-threatening medical complications and the development of massive heterotopic ossification. View this table: TABLE I Reported Cases of Acute Compartment Syndrome of the Thigh Secondary to Intense Exercise The patient agreed to have the data concerning the case submitted for publication. A twenty-two-year-old male body-builder had been taking creatine monohydrate (20 g/day) as a nutritional supplement for four months when acute thigh and leg cramping developed, followed by five days of the passage of dark urine. The symptoms developed over a two-week period while the man was performing high-repetition, free-weight lower-extremity exercises. He was admitted to a local community hospital with symptoms of nausea, vomiting, uncontrollable thigh pain, and the inability to walk. Three days after admission, he was transferred to our institution with a delayed diagnosis of acute compartment syndrome of the thighs. Prior to his transfer, anterior thigh compartment pressure was reported to be elevated bilaterally (65 mm Hg). Physical examination performed following the transfer demonstrated tense thighs and legs. The clinical symptoms, however, appeared to have abated slightly compared with the initial presentation three days previously. The patient did not have …