Medline ® Abstracts for References 93,94

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.

Anterior compartment syndrome of the thigh resulting from blunt contusion without an accompanying fracture is rare. The treatment advocated for it by most authors has been surgical. However, because wound infection rates are high and loss of knee range of motion is frequent, we considered conservative treatment in selected patients. Six athletes who developed an anterior thigh compartment syndrome shortly after sustaining a blunt contusion to the quadriceps with an accompanying massive hematoma were studied prospectively. Tissue pressure, renal function, and creatinine phosphokinase (CPK) levels were closely monitored. Fasciotomy was not performed, despite sustained pressure elevations above 50 mm Hg. Neurologic function was not affected. At follow-up examination 1 year later, no limitation of joint motion nor weakness of the quadriceps were observed. Thus in selected young patients in whom an isolated anterior compartment syndrome of the thigh occurs, conservative treatment yielded results superior to fasciotomy.