Elsevier

Injury

Volume 41, Issue 2, February 2010, Pages 133-136
Injury

Review
Compartment syndrome of the thigh: A systematic review

https://doi.org/10.1016/j.injury.2009.03.016Get rights and content

Abstract

Introduction

Thigh compartment syndrome is a surgical emergency with risk of high morbidity and mortality rates. The purpose of this study was to review the available evidence regarding the causes of thigh compartment syndrome, techniques of fasciotomy (specifically, one versus two incisions), methods of wound closure, and complications.

Methods

This institutional review board-exempt study was performed at a level-one trauma centre. PubMed and Medline OVID databases in the English language were searched for case series of two or more cases of compartment syndrome of the thigh. Cases were reviewed and analysed for causes of thigh compartment syndrome, number of fasciotomy incisions, methods of wound closure, and complications.

Results

A total of 9 papers met our criteria. All were retrospective case studies comprising a total of 89 patients. The most common cause was blunt trauma (90%). Motor vehicle accidents accounted for 36% of cases whilst motorcycle accidents were involved in 9%. Associated injuries included femur fractures in 48%, other limb fractures, renal, cardiovascular and head insults. Eighty-six percent of fasciotomies were performed through a single incision. Fifty-nine percent of fasciotomy wounds were closed by delayed primary closure, 26% had split-thickness skin grafts, and 15% had primary wound closure. Neurological deficits were the most common complications.

Conclusion

There are limited data on thigh compartment syndrome with respect to cause, use of one versus two incisions for fasciotomy, methods of wound closure, and complication rates. Prospective studies are required to better define these variables in order to optimise the management of this problem.

Introduction

Compartment syndromes are one of the more common sources of medical litigation, with significant malpractice liability.1 Compartment syndrome of the thigh is a rare orthopaedic emergency in which the pressure within the osteofascial compartment of the thigh rises above the capillary perfusion pressure gradient causing cellular anoxia, muscle ischaemia, and death.

One study reported 44% of patients with acute compartment syndrome of the thigh suffered persistent long-term functional deficits.9 A mortality rate of 47% was reported by Schwartz et al.14 Factors affecting functional outcome of thigh compartment syndrome appear to be age, polytrauma, femoral fractures, and time to fasciotomy.9 To our knowledge, there are limited data regarding the management of this problem.

The paucity of publications on this topic led to this review. The purpose of this study is to systematically review the available evidence regarding the causes of thigh compartment syndrome, number of fasciotomy incisions (specifically, one versus two incisions), methods of wound closure, and complications.

Section snippets

Materials and methods

This was an institutional review board-exempt study performed at a level-one trauma centre. A search of the PubMed database using the key words thigh, compartment syndrome yielded a total of 170 articles. Next, a Medline OVID database search was conducted using the medical subject headings thigh and compartment syndrome. The OVID search was limited to full text articles in the English language from core clinical journals. This yielded 101 articles. Similarly, a search of the EMBASE database

Literature search

A total of 9 articles with 89 cases of thigh compartment syndrome (13 female and 76 male) met our criteria (Table 1).4, 5, 8, 9, 13, 14, 16, 17, 18 All studies were retrospective case series. Of these, 54 patients were available for follow-up with a mean follow-up of 20 months postoperatively (range, 1–63 months).5, 9, 13, 14, 17, 18 The average age of the patients was 38 years (range, 12–81 years).

Causes of acute thigh compartment syndrome

Ninety percent of thigh compartment syndrome cases were attributed to blunt trauma (Table 2).

Complications

Our analysis of common complications (Table 4) observed in 81 cases from 8 studies demonstrated that neurological deficits were the most common (16%).4, 5, 8, 9, 13, 14, 17, 18 One study did not record complications. Schwartz et al.14 reported mortality rates as high as 47% in their review. Mortality was shown to be mainly due to polytrauma and infection.8, 14 In many cases, the precise cause of death could not be ascertained due to failure of multiple organ systems. However, head injury, renal

Discussion

Compartment syndrome of the thigh does not occur as frequently as compartment syndrome of the calf. In this systematic review, we attempted to gain valuable information about the current practice of care in regard to this serious post-traumatic complication. Due to the small number of patients, no robust conclusions could be reached in terms of the requirement of one-incision versus two-incision technique for fasciotomy, wound closure techniques, and complications. Nonetheless, we were able to

Conclusions

There are limited data on thigh compartment syndrome with respect to cause, use of one versus two incisions for fasciotomy, methods of wound closure, and complication rates. Prospective studies are required to better define these variables in order to optimise the management of thigh compartment syndrome.

Conflict of interest

The authors state that there is no conflict of interest.

References (18)

  • T. Suzuki et al.

    Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma

    Inj Int J Care Injured

    (2005)
  • R.B. Bourne et al.

    Compartment syndrome of the lower leg

    Clin Orthop Rel Res

    (1989)
  • B.M. Cascio et al.

    Compartment syndrome: time from diagnosis to fasciotomy

    J Surg Orthop Adv

    (2005)
  • J.A. Finkelstein et al.

    Lower limb compartment syndrome: course after delayed fasciotomy

    J Trauma

    (1996)
  • M. Hsieh et al.

    Acute thigh compartment syndrome following thigh trauma: a report of three cases

    Formos J Surg

    (2003)
  • S.C. Klasson et al.

    Acute anterior thigh compartment syndrome complicating quadriceps hematoma: 2 case reports and a review of the literature

    Orthop Rev

    (1990)
  • F.A. Matsen et al.

    Diagnosis and management of compartment syndrome

    J Bone Joint Surg Am

    (1980)
  • M.M. McQueen et al.

    Compartment monitoring in tibial fractures: the pressure threshold for decompression

    J Bone Joint Surg Br

    (1996)
  • K. Mithofer et al.

    Clinical spectrum of acute compartment syndrome of the thigh and its relationship to associated injures

    Clin Orthop Rel Res

    (2004)
There are more references available in the full text version of this article.

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