Compartment Syndrome of the Leg After Less Than 4 Hours of Elevation on a Fracture Table

Russell Meldrum, MD, Paul Lipscomb, MD

Disclosures

South Med J. 2002;95(2) 

In This Article

Abstract and Introduction

Compartment syndrome of the leg is usually associated with significant trauma. It has also been associated with prolonged surgery in the hemilithotomy position. Fracture tables that are used for the internal fixation of proximal femur fractures under fluoroscopy place a patient in this position. This report chronicles two cases of intraoperative compartment syndrome of the leg that was elevated and contralateral to a subtrochanteric femoral fracture. In each case, the syndrome was found at the procedure's conclusion and was addressed with fasciotomies. One patient continued to have neurologic sequelae from the compartment syndrome 2 years later.

Compartment syndrome of the leg is usually associated with open or closed tibial fractures from blunt or penetrating forces. Even if no fracture is apparent, the usual presentation carries a history of significant trauma.[1] One subtle cause of compartment syndrome that has been reported is positioning on an operating table during prolonged surgery. This subtle cause has been identified in both the lithotomy[2,3,4,5] and hemilithotomy positions[6] and is thought to be the result of prolonged elevation of the patient's legs.[7,8,9,10] The lithotomy position is commonly used for urologic and abdominal surgeries, whereas in orthopedics the hemilithotomy position allows easy surgical exposure of the hip and proximal femur for intramedullary and extramedullary fracture stabilization under fluoroscopic guidance.[11] Its use is imperative in the placement of proximal and distal interlocking screws under fluoroscopy. The leg contralateral to the fracture is placed on a well-padded stirrup that places pressure on the posterior aspect of the calf. In this position, the knee and hip are flexed; the hip is abducted and internally rotated. Although this position and the use of fracture tables are safe, previous reports have chronicled this subtle cause of leg compartment syndrome in long surgical cases.[6] In this report, we present two additional cases of nontraumatic compartment syndrome of the leg attributed to the hemilithotomy position on two types of orthopedic fracture tables during internal fixation of subtrochanteric femoral fractures. In both of these cases, the procedure went without difficulty, with shorter operative times than those reported in previously published cases of compartment syndromes.

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