Spontaneous compartment syndrome of the foot

Compartment syndrome of the foot is usually associated with trauma, and if untreated may result in deformity and loss of function. We report a case of spontaneous compartment syndrome of the foot presenting with severe unremitting pain. The diagnosis was supported by measurements of compartment pressures and the symptoms resolved after surgical decompression. Spontaneous compartment syndrome in the leg has been described in a small number of cases, but there has been no previous report involving the foot. We believe that this case highlights the importance of suspecting a spontaneous compartment syndrome of the foot if the appropriate symptoms are present but there is no clear cause. We also believe that compartment pressure measurement assists in the decision to undertake surgical decompression.     

Posterior Tibial Nerve Lymphoma Presenting as Tarsal Tunnel Syndrome: A Case Report

We report a case of isolated posterior tibial B-cell lymphoma of the posterior tibial nerve presenting as tarsal tunnel syndrome. This diagnosis was considered because of the clinical presentation and electrophysiologic abnormalities. It was further confirmed by the magnetic resonance imaging findings of the ankle and tissue pathologic findings. Whole body positron emission tomography confirmed this to be a localized lymphoma involving the peripheral nerve. The patient underwent chemotherapy with complete tumor resolution. She had had no relapse after 8 months of follow-up. Isolated peripheral nerve lymphomas are very rare, and involvement of the posterior tibial nerve has not been previously reported. Furthermore, the present case report highlights the importance of the clinical examination in the diagnosis of tarsal tunnel syndrome before performing surgical decompression.     

Gluteal compartment syndrome following joint arthroplasty under epidural anaesthesia: a report of 4 cases

Compartment syndrome is characterised by an increase in the interstitial pressure within a closed osseofascial compartment. This may be due to a decrease in compartment volume, an increase in compartment content or external pressures. We report 4 patients who required surgical decompression for gluteal compartment syndrome that developed after joint arthroplasty. Gluteal compartment syndrome is rare, has high morbidity, and can be life threatening if not detected early. We emphasise the importance of identifying patients at risk, frequent monitoring of patients with continuous epidural infusions, reporting of motor blockade, and regular changing of the patient's position postoperatively.     

Abdominal compartment syndrome caused by tension pneumoperitoneum in a scuba diver

Abdominal compartment syndrome is a surgical emergency caused by a raised intra-abdominal pressure, which may lead to respiratory, cardiovascular and renal compromise. It is most commonly seen in post-operative and trauma patients and it has a variety of causes. Tension pneumoperitoneum (TP) is a rare cause of abdominal compartment syndrome most often seen after gastrointestinal endoscopy with perforation.We present the case of a fit 52-year-old experienced female diver who developed TP and shock following a routine training dive to 27m. Following accidental inhalation of water, she had an unstaged ascent and, on reaching the surface, developed severe acute abdominal pain and distension. She was brought to our emergency department by air ambulance for assessment. Clinical and radiological examination revealed a shocked patient with dramatic free intra-abdominal gas and signs of abdominal compartment syndrome, which was treated with needle decompression. Symptoms and signs resolved quickly with no need for further surgical intervention. TP is a surgical emergency where surgery can be avoided with prompt diagnosis and treatment.     

Acute compartment syndrome complicating a distal tibial physeal fracture in a neonate.

This case report of a neonate who developed an acute compartment syndrome secondary to a minimally displaced distal tibial physeal injury represents the youngest patient to be reported with such a condition. After undergoing emergency four-compartment decompression fasciotomies, the 4-week-old child had a return of normal neuromuscular function and anatomic remodeling of the fracture. It is difficult to diagnose compartment syndrome in a neonate. The patient can neither give a history, nor follow commands to cooperate with the exam. The physician must rely primarily on the physical examination; however, the quantitative measurement of intracompartmental pressure can corroborate the diagnosis of compartment syndrome. We have found using a monometer to measure intracompartmental pressure to be helpful in conjunction with a physical exam when evaluating a neonate suspected of having a compartment syndrome.     

The ‘silent’ compartment syndrome

Intractable pain out of proportion to the injury sustained is considered to be the earliest and most reliable indicator of a developing compartment syndrome. We report 4 cases where competent sensate patients developed compartment syndromes without any significant pain. The first patient developed a painless compartment syndrome in the well leg following surgery for femoral fracture on the other side. The second patient developed the silent compartment syndrome post-operatively following a tibial nailing for a tibial fracture. The third patient presented with the painless compartment syndrome following a tibial plateau fracture. Our prevailing culture of a high-index of clinical suspicion and surveillance prompted us to perform compartment pressure measurements. The surgical findings at immediate fasciotomy confirmed the diagnoses.Our experience indicates that pain is not a reliable clinical indicator for underlying compartment syndrome, so in a competent sensate patient the absence of pain does not exclude compartment syndrome.We believe that a high index of clinical suspicion must prevail in association with either continuous compartment pressure monitoring or frequent repeated documented clinical examination with a low threshold for pressure measurement.     

Surgical decompression for abdominal compartment syndrome after emergency cardiac surgery

Abdominal compartment syndrome typically occurs in patients after abdominal surgical procedures or trauma. Abdominal compartment syndrome is also increasingly described in conditions not related to abdominal operations, such as fluid resuscitation or burns. We report two patients who required surgical abdominal decompression for abdominal compartment syndrome that developed early after emergency coronary artery bypass graft surgery. No intraabdominal abnormalities were found at operation. Both patients had a protracted clinical course, but they survived and were discharged from the hospital.     

Abdominal compartment syndrome: a situation thet needs to be better known

Abdominal compartment syndrome was initially described as a cascade of physiopathological events triggered by the increase in intra-abdominal pressure induced by a surgical procedure for aneurysm of the abdominal aorta. In practice, it is a complication that can arise after various procedures; it has a multi-organ impact and can lead to exitus. We retrospectively analyzed a total of 9 patients with abdominal compartment syndrome. In 5 cases onset of the syndrome was due to a secondary complication of a vascular procedure (3 mesenteric, 2 renal). The clinical data characterizing the disease included abdominal distension and reduced diuresis. In all cases the finding of increased necrosis scores (LDH, CPK) was evident, while the appearance of leukocytosis occurred only in 4 (44%). The basic treatment was surgical decompression. In one case we obtained an excellent result with medical treatment alone, consisting in steroids and PGE1; these were useful in all cases in which an inflammatory bowel component played a role. Our experience encourages us to stress the importance of early assessment of abdominal hypertension in patients with a potential risk of abdominal compartment syndrome. In this phase, appropriate medical and supportive treatment could limit the surgical indications or at any rate favour the healing process after surgical decompression, the basic treatment indicated for this syndrome.     

Lower limb compartment syndrome following lumbar discectomy in the knee-chest position

We report on two cases of compartment syndrome following lumbar discectomy in the knee-chest position. This complication has only been described once since 1953. Seven cases of compartment syndrome following other surgical procedures were found in the literature. Any increases in tissue pressure of a muscle compartment exceeding 35–40 mmHg over a longer period of time can result in this complication for example, too tight cast, space-occupying intrafascial bleeding, or postischemic swelling. The diagnosis is purely clinical and is based on the typical combination of extremely painful edema with rapid onset of sensory loss and subsequent motor deficits. The muscle necrosis leads to myoglobinaemia and myoglobinuria, recognizable by brown urine. The therapy consists of urgent fasciotomy of swollen compartements without skin suture. The prognosis is highly dependent on the time of the surgical decompression: within 6 hours serious deficits are avoidable; after 24 hours irreversible necrosis of muscle occurs. It seems that the possibility of a compartment syndrome is a specific, but a rare risk of a prolonged knee-chest position.     

The segmental tibial fracture.

A series of 31 segmental tibial fractures is reported. Eighty-four percent of the patients sustained multiple trauma and 80% of these were open fractures. The series includes treatment with 20 external fixators, seven unreamed intramedullary nails, two casts, and two amputations. Complications included a 48% incidence of elevated compartment pressures necessitating fasciotomy. Despite rapid early decompression, there was a 19% incidence of residual motor and sensory deficit. Other complications observed were a 35% incidence of wound infection, nonunion, and malunion. Eighty-one percent of delayed or nonunions occurred at the distal fracture site. Intramedullary nailing produced the fewest complications. The segmental tibial fracture is at high risk for complications. Close observation of the limb for high compartment pressures is advisable. Treatment for compartment syndrome includes prompt decompression and stabilization of the fracture and, as indicated, intramedullary rods without preliminary reaming.     

Does patient controlled analgesia delay the diagnosis of compartment syndrome following intramedullary nailing of the tibia?

We report on four cases in which the diagnosis of compartment syndrome was delayed by the administration of patient controlled analgesia (PCA) following intramedullary nailing of tibial shaft fractures. We believe that this poses a diagnostic problem and can lead to lasting sequelae as decompression is delayed. We recommend extra vigilance with the use of PCA in patients with intramedullary nailing following tibial shaft fractures.     

Neonatal Volkmann's compartment syndrome. A report of two cases

Neonatal Volkmann's compartment syndrome is a rare entity. This diagnosis may be suspected when a case presents cutaneous damage associated with poor hand and wrist function after delivery. We present two such cases of neonatal Volkmann compartment syndrome with long term clinical and x-ray follow-up. In our patients, a hand surgeon was not consulted in the perinatal period and early fasciotomy was not performed. No particular aetiology or associated cerebrovascular accident was found. A series of operations was necessary in order to improve function of the hand. Neonatal Volkmann compartment syndrome must be recognised early in order to enable further investigation of any underlying condition and to perform early surgical decompression. Long term clinical and x-ray follow-up is necessary to prevent and treat wrist deformation and finger contractures.     

Endoscopic-assisted Fascial Decompression for Forearm Exertional Compartment Syndrome: A Case Report and Review of the Literature

A case of chronic exertional compartment syndrome of the forearm treated with endoscopic-assisted fascial decompression is presented. The diagnosis of exertional compartment syndrome of the forearm was confirmed by direct measurement of intracompartmental pressures. Following endoscopic-assisted fascial decompression, the patient was able to begin rehabilitation therapy within 2 weeks. There were no wound-related complications. The patient reported no recurrence of symptoms after returning to work requiring heavy lifting, and morbidity associated with open decompression was avoided. Endoscopic release is not an option in traumatic compartment syndrome, but a minimally invasive approach may be considered in cases of exertional compartment syndrome. Reports of endoscopic-assisted fascial decompression in exertional compartment syndrome of the forearm are relatively scarce. Confirmation of the safety and efficacy of these evolving techniques in the hand surgery literature remains important.     

Calcaneal compartment syndrome after tibial fractures

Compartment syndrome of the newly discovered calcaneal compartment of the foot is a theoretical possibility following tibial fracture due to the communication with the deep posterior compartment of the calf. Forty-nine patients were reviewed at least 18 months after open or closed tibial shaft fractures treated with tibial nailing in order to determine the prevalence of foot deformities secondary to previously undetected calcaneal or leg compartment syndromes. Ankle movements, foot height, length of feet and degree of clawing of the toes were all measured and compared with the unaffected opposite side. None of the patients complained of any symptoms from their feet and none had any significant foot deformities. Calcaneal compartment syndrome is rare after tibial fracture and routine measurement of calcaneal compartment pressures after such injuries is not indicated.     

Forced march-induced peroneal compartment syndrome. A report of two cases.

Isolated exertional peroneal compartment syndrome is rare. Two cases are described after prolonged forced march in highly conditioned United States Marines. Measured compartment pressures were over 100 mm Hg. No permanent impairment resulted after surgical decompression.     

Compartment syndrome: a review of the literature

Compartment syndrome is a rare but severe complication of lower extremity trauma. This article provides an extensive review of the literature, including incidence, physical examination findings, pathophysiology, compartment pressure evaluation, and surgical decompression techniques. Most of the recent compartment syndrome literature shows case reports of atypical causes of this limb-threatening disorder. Although the emphasis of this article is traumatic compartment syndrome, recent literature on chronic lower extremity compartment syndrome, secondary to exercise or activity, is also discussed.     

Presentation of compartment syndrome without an obvious cause can delay treatment. A case report

Compartment syndrome is a serious condition which leads to chronic morbidity unless an urgent decompression of the affected area is performed. An increased intra compartmental pressure commonly occurs after a physical insult though rarer causes have been identified. We report an atypical presentation of compartment syndrome and subsequent delayed intervention where there was no identifiable aetiological factor. Frontline medical staff must rule out compartment syndrome early so that complications secondary to compartment syndrome can be avoided.     

Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction.

Extravasation of irrigation fluid during arthroscopy is a well-known complication. We report a case of accumulation of fluid into the calf during open wedge high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament (ACL) reconstruction. The main cause for fluid extravasation was the drilling of the tibial tunnel, which allowed the fluid to cross the osteotomy gap and invade the flexor compartments. Although an elevation of the intracompartmental pressure was measured, there was no clinical evidence of compartment syndrome. A subcutaneous release of the flexor compartment of the leg was performed. The patient suffered no further sequelae. High tibial osteotomy combined with simultaneous arthroscopic ACL reconstruction has to be performed carefully, and potential complications must be detected immediately to prevent compartment syndrome.     

Teflon granuloma after microvascular decompression for hemifacial spasm: a case report and literature review

Teflon has been commonly used as a surgical material. In particular, Teflon has been considered suitable for microvascular decompression of cranial nerves, as it is a stable, inert substance that does not resorb or migrate. Giant cell foreign body reactions after microvascular decompression (MVD) have been reported, but this rare complication has not been well recognized. Here, we report one case of Teflon granuloma that occurred 4 years after MVD for hemifacial spasm. We discuss the cause, histopathological analysis, particular MVD surgical methods, and management of Teflon granuloma.     

Bilateral gluteal compartment syndrome after total hip arthroplasty under epidural anesthesia

The gluteal compartment syndrome is uncommon and is discussed in only a few published case reports. The simultaneous bilateral gluteal compartment syndrome is exceptionally rare and is tackled in only 4 case reports to date. We report a case of bilateral gluteal compartment syndrome after total hip arthroplasty under epidural anesthesia and discuss its management.