Delayed Onset of Anterior Tibial Compartment Syndrome in a Patient Receiving Low-Molecular-Weight Heparin. A Case Report*

Abstract

Patients who have sustained a major traumatic injury of a lower extremity are at high risk for the development of deep-vein thrombosis. The use of low-molecular-weight heparin for prophylaxis against deep-vein thrombosis in such patients has been advocated by several authors2,4,5,7,9,12. Major complications attributed to the use of low-molecular-weight heparin have included hemorrhage2,8 and spinal epidural hematoma13. Compartment syndrome usually is associated with high-energy or crush injuries. The symptoms of compartment syndrome usually present within twenty-four to forty-eight hours. Compartment syndromes occurring in the absence of an underlying osseous injury are unusual. We describe a case of delayed-onset compartment syndrome of the leg in a patient who was receiving low-molecular-weight heparin. A thirty-three-year-old man sustained injuries of the left lower extremity in a motor-vehicle accident. The patient was otherwise healthy and had no known hepatic, clotting, or bleeding abnormalities. Physical and radiographic examination revealed closed segmental fractures of the left femur and tibia. Physical examination of the right lower extremity revealed several small, superficial abrasions. There was no swelling or ecchymosis. The compartments of the right thigh and leg were soft, and neurovascular function was intact. Anteroposterior and lateral radiographs of …