The patient was transferred to a central hospital for further treatment of the tibial fracture. ACS was diagnosed and a four compartment fasciotomy was performed to decompress the lower leg compartments. One and a half days after the accident, motor function was absent in the lower left leg and absence of sensation in the foot was noted. A CT-scan of the left knee was performed and the joint was temporarily immobilised with an upper plaster splint. The patient had only sustained a comminuted fracture of the left tibial plateau (Fig. She was treated according to the principles of the Advanced Trauma Life Support (ATLS). Patient A, a healthy 28-year-old female, was seen at the Emergency Department of a regional hospital after an accident with her scooter she hit a post with her lower leg. We also give a review of the diagnostic possibilities and suggest guidelines to recognise the compartment syndrome in its early phases. In this publication, we describe three patients with a complicated course of ACS of the lower leg after trauma. Early treatment is mandatory in order to achieve a good result. There is a consensus that opening the four compartments of the lower leg as wide as possible and decompressing is the only method adequate to treat ACS. In stark contrast to the controversy surrounding diagnosis, more agreement exists about the treatment of ACS. In some cases, intra-compartmental pressure measurement can facilitate diagnosis. Patient history and physical examination are very important in making the diagnosis. The amount of pain experienced and, particularly, the discrepancy between the seriousness of pain in comparison with the extent of trauma can be an indication for the existence or the development of an ACS. No gold standard exists for diagnosing ACS. The timely recognition of ACS of the lower leg can be difficult because it can be caused by minimal trauma or masked by a concomitant trauma. Postponing treatment because of late recognition and additional time-consuming diagnostic procedures increases the risk of complications. Prognosis for full recovery is strongly dependent on an early diagnosis and treatment. In some cases, the ACS can result in a life-threatening condition. The acute compartment syndrome of the lower leg is a surgical emergency and should be dealt with immediately.Īcute compartment syndrome (ACS) of the lower leg that is not recognized and left untreated can lead to loss of the affected extremity. Although the diagnosis can be difficult, delays in treatment should be avoided at all costs. The eventual outcome of this syndrome is directly related to the time elapsed between diagnosis and definitive treatment. After confirmation of the diagnosis, immediate fasciotomy of all lower leg compartments should be performed. Under these circumstances, intra-compartmental pressure measurement can be of great assistance. In some cases, however, a reliable diagnosis cannot be made clinically, as in the case of unconscious, intoxicated or intubated patients, as well as small children. Moreover, patient history (pain out of proportion to the associated injury) and physical examination are central to the diagnosis. In most cases, acute compartment syndrome of the lower leg is seen in combination with a fracture (40%), although other causes (minor trauma or vascular surgery) are also known. In the youngest patient, the lower leg was able to be saved after extensive reconstructive surgery. Due to delay in diagnosis, severe complications developed, resulting in two transfemoral amputations. Three patients, two adults and one child, developed an acute compartment syndrome of the lower leg.
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