Abstract
Compartment syndromes of the thigh after blunt trauma without any fracture are rare. Most surgeons recommend operative treatment. There are different rules for compartment syndromes of the thigh in young athletes after blunt trauma compared to compartment syndromes at other locations [(1) the large volume of the quadriceps muscle, (2) its relatively elastic fascia, (3) the direct proximal contact to the hip muscles which allows extravasation of fluid out of the compartment)]. We present a case of conservative treatment of elevated intra-compartmental pressure (ICP) of the anterior thigh after blunt trauma and the follow-up until return to sport. Conservative treatment of a compartment syndrome of the thigh after blunt trauma in a young patient without fracture or vascular damage was successful without short-term sequelae. Recovery of muscle strength is delayed but return to sport is possible. Depending on the severity the diagnosis and follow-up with ICP measurements and MRI is necessary. There is a very good chance for excellent outcome without any risk of surgery. However, a long healing time is possible.
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Allen MJ, Stirling AJ, Crawshaw CV, Barnes MR (1985) Intracompartmental pressure monitoring of leg injuries. an aid to management. J Bone Joint Surg Br 67(1):53–57
An HS, Simpson JM, Gale S, Jackson WT (1987) Acute anterior compartment syndrome in the thigh: a case report and review of the literature. J Orthop Trauma 1(2):180–182
Breidahl WH, Newman JS, Taljanovic MS, Adler RS (1996) Power Doppler sonography in the assessment of musculoskeletal fluid collections. AJR Am J Roentgenol 166(6):1443–1446
Burns BJ, Sproule J, Smyth H (2004) Acute compartment syndrome of the anterior thigh following quadriceps strain in a footballer. Br J Sports Med 38(2):218–220
Bush CH (2000) The magnetic resonance imaging of musculoskeletal hemorrhage. Skeletal Radiol 29(1):1–9
Colosimo AJ, Ireland ML (1992) Thigh compartment syndrome in a football athlete: a case report and review of the literature. Med Sci Sports Exerc 24(9):958–963
Diaz JA, Fischer DA, Rettig AC, Davis TJ, Shelbourne KD (2003) Severe quadriceps muscle contusions in athletes. a report of three cases. Am J Sports Med 31(2):289–293
Gorman PW, McAndrew MP (1987) Acute anterior compartmental syndrome of the thigh following contusion. a case report and review of the literature. J Orthop Trauma 1(1):68–70
Hargens AR, Romine JS, Sipe JC, Evans KL, Mubarak SJ, Akeson WH (1979) Peripheral nerve-conduction block by high muscle-compartment pressure. J Bone Joint Surg Am 61(2):192–200
Jackson DW, Feagin JA (1973) Quadriceps contusions in young athletes. Relation of severity of injury to treatment and prognosis. J Bone Joint Surg Am 55(1):95–105
Janzing HM, Broos PL (2001) Routine monitoring of compartment pressure in patients with tibial fractures: beware of overtreatment! Injury 32(5):415–421
Klasson SC, Vander Schilden JL (1990) Acute anterior thigh compartment syndrome complicating quadriceps hematoma. Two case reports and review of the literature. Orthop Rev 19(5):421–427
Matsen FA III, Winquist RA, Krugmire RB Jr (1980) Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am 62(2):286–291
McQueen MM, Court-Brown CM (1996) Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 78(1):99–104
Mithofer K, Lhowe DW, Altman GT (2002) Delayed presentation of acute compartment syndrome after contusion of the thigh. J Orthop Trauma 16(6):436–438
Mithofer K, Lhowe DW, Vrahas MS, Altman DT, Altman GT (2004) Clinical spectrum of acute compartment syndrome of the thigh and its relation to associated injuries. Clin Orthop 425:223–229
Moyer RA, Boden BP, Marchetto PA, Kleinbart F, Kelly JDt (1993) Acute compartment syndrome of the lower extremity secondary to noncontact injury. Foot Ankle 14(9):534–537
Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH (1978) Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg Am 60(8):1091–1095
Mulder K, Sakoman V, Kecskes S, Schulte P (1991) [Compartment syndrome after femoral contusion. Case report and review of the literature]. Aktuelle Traumatol 21(4):139–142
Newnham MS, Mitchell DI (2001) Compartment syndrome of the thigh. A case report and review of the literature. West Indian Med J 50(3):239–242
Robinson D, On E, Halperin N (1992) Anterior compartment syndrome of the thigh in athletes–indications for conservative treatment. J Trauma 32(2):183–186
Rooser B (1987) Quadriceps contusion with compartment syndrome. Evacuation of hematoma in 2 cases. Acta Orthop Scand 58(2):170–172
Rooser B, Bengtson S, Hagglund G (1991) Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases. J Orthop Trauma 5(1):57–59
Tiwari A, Haq AI, Myint F, Hamilton G (2002) Acute compartment syndromes. Br J Surg 89(4):397–412
Viegas SF, Rimoldi R, Scarborough M, Ballantyne GM (1988) Acute compartment syndrome in the thigh. A case report and a review of the literature. Clin Orthop (234):232–234
Volkmann R (1881) Die ischaemischen muskellahmungen und Kontrakturen. Centralbl Chir 8:801.3
Whitesides TE Jr, Haney TC, Harada H, Holmes HE, Morimoto K (1975) A simple method for tissue pressure determination. Arch Surg 110(11):1311–1313
Winternitz WA Jr, Metheny JA, Wear LC (1992) Acute compartment syndrome of the thigh in sports-related injuries not associated with femoral fractures. Am J Sports Med 20(4):476–477
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Riede, U., Schmid, M.R. & Romero, J. Conservative treatment of an acute compartment syndrome of the thigh. Arch Orthop Trauma Surg 127, 269–275 (2007). https://doi.org/10.1007/s00402-006-0199-1
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DOI: https://doi.org/10.1007/s00402-006-0199-1