Compartment Syndrome: an Acute Femoral Stress Fracture in a Young Male Athlete
Tóm tắt
The incidence of an acute compartment syndrome (ACS) of the thigh is less than 1%. It is most common in the setting of muscle overuse or muscle injury, as well as secondary to trauma, such as a femoral fracture. We present a case of an ACS in a young, healthy, and semiprofessional athlete with normal coagulation who sustained an acute stress fracture of the distal femur. After the initial fracture osteosynthesis, the patient suffered from a compartment syndrome in the right anterior aspect of the distal thigh. Following rapid surgical fasciotomy, the case was uneventful, and he returned to his preinjury sport level without any neurological consequences. This case confirms that ACS in the thigh is rare, but mainly occurs in young males with a large muscle mass due to participation in various athletic programs. We hypothesize that constant muscle over-usage primes for a larger amount of contused and protruding muscle mass in the small femoral compartment. Hence, the fatigued muscle subjects the bone to an increased mechanical force resulting in an overloading process. This ensues the accumulation of femoral microfractures and primes for the occurrence of an increased rate of stress fractures and an ACS in the thigh.
Tài liệu tham khảo
Aro H, Dahlstrom S (1986) Conservative management of distraction-type stress fractures of the femoral neck. J Bone Joint Surg (Br) 68(1):65–67
Badhe S, Baiju D, Elliot R, Rowles J, Calthorpe D (2009) The ‘silent’ compartment syndrome. Injury. 40:220–222
Colosimo AJ, Ireland ML (1992) Thigh compartment syndrome in a football athlete: a case report and review of the literature. Med Sci Sports Exerc 24:958–963
Egol KA, Koval KJ, Kummer F, Frankel VH (1998) Stress fractures of the femoral neck. Clin Orthop Relat Res 348:72–78
Fredericson M, Jennings F, Beaulieu C, Matheson GO (2006) Stress fractures in athletes. Top Magn Reson Imaging 17(5):309–325
Gorman PW, McAndrew MP (1987) Acute anterior compartment syndrome of the thigh following contusion. A case report and review of the literature. J Orthop Trauma 1:68–70
Gourgiotis S, Villias C, Germanos S, Foukas A, Ridolfini MP (2007) Acute limb compartment syndrome: a review. J Surg Educ 64(3):178–186
Gutfraynd A, Philpott S (2016) A case of acute atraumatic compartment syndrome of the thigh. J Emerg Med 51(3):45–47
Kahan JS, McClellan RT, Burton DS (1994) Acute bilateral compartment syndrome of the thigh induced by exercise. A case report. J Bone Joint Surg Am 76(7):1068–1071
King TW, Lermann OZ, Carter JJ, Warren SM (2010) Exertional compartment syndrome of the thigh: a rare diagnosis and literature review. J Emerg Med 39(2):93–99
Matsen FA 3rd, Winquist RA, Krugmire RB Jr (1980) Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am 62(2):286–291
McCaffrey DD, Clarke J, Bunn J, McCormack M (2009) Acute compartment syndrome of the anterior thigh in the absence of fracture secondary to sporting trauma. J Trauma 66:1238–1242
McDonald LS, Mitchell RJ, Deaton TG (2012) Bilateral compartment syndrome of the anterior thigh following functional fitness exercise: a case report. Mil Med 177(8):993–996
McQueen MM, Gaston P, Court-Brown C (2000) Acute compartment syndrome. Who is at risk? J Bone Joint Surg 82(2):200–203
McQuerry JL, Burnham JM, Ireland ML, Wright RD (2018) Delayed presentation of compartment syndrome of the thigh in a previously undiagnosed Factor VII-deficient high school football athlete: a case report. J Bone Joint Surg Case Connect 8(1):e1–e4
Mithoefer K, Lhowe DW, Vrahas MS, Altman DT, Erens V, Altman GT (2006) Functional outcome after acute compartment syndrome of the thigh. J Bone Joint Surg Am 88(4):729–737
Nau T, Menth-Chiari WA, Seitz H, Vecsei V (2000) Acute compartment syndrome of the thigh associated with exercise. Am J Sports Med 28(1):120–122
Ojike N, Roberts C, Giannoudis P (2010) Compartment syndrome of the thigh: a systemic review. Injury. 41:133–136
Patti BN, Pfefferle KJ, Meyer T (2014) Bilateral compartment syndrome of the thigh in a college football athlete. J Bone Joint Surg Case Connect 4(1):1–4
Riede U, Schmid M, Romero J (2007) Conservative treatment of an acute compartment syndrome of the thigh. Arch Orthop Trauma Surg 127:269–275
Roeoesser B, Bengtson S, Haegglund G (1991) Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases. J Orthop Trauma 5:57–59
Saber A (2014) Compartment syndromes. J Acute Dis 3:169–177
Schwarz JT Jr, Brumback RJ, Lakatos R, Poka A, Bathon GH, Burgess AR (1989) Acute compartment syndrome of the thigh. A spectrum of injury. J Bone Joint Surg Am 71(3):392–400
Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O’Brien PJ (2015) Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adult. J Orthop Traumatol 16:185–192
Smith RDJ, Rust-March H, Kluzek S (2015) Acute compartment syndrome of the thigh in a rugby player. Case Reports, bcr2015210856
Taylor RM, Sullivan MP, Mehta S (2012) Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk. Curr Rev Muskuloskelet Med 5:206–213
Winternitz WA, Metheny JA, Wear LC (1992) Acute compartment syndrome of the thigh in sports-related injuries not associated with femoral fractures. Am J Sports Med 20:476–478
Zuchelli D, Divaris N, McCormack JE, Huang EC, Chaudhary ND, Vosswinkel JA, Jawa RS (2017) Extremity compartment syndrome following blunt trauma: a level I trauma center’s 5-year experience. J Surg Res 217:131–136
