Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report

Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report

Compartment syndrome, Crush syndrome, Gluteal compartment syndrome, Thigh compartment
syndrome, Fasciotomy

Abstract

Background Compartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compart-
ment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome

be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis
and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions
or in the ipsilateral gluteal region and thigh.
Case presentation We report on a 76-year-old man who was obliquely crushed under a tree extending

from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with com-
partment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was per-
formed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intra-
compartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes.

A fasciotomy was performed, the gluteal skin incision was made according to the Kocher–Langenbeck approach (one
of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This
surgical approach enabled the decompression of the compartments through a single incision and allowed for easier
wound treatment and closure.
Conclusion This case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions.
Extension of the Kocher–Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral
gluteal and thigh compartment syndrome.
Keywords Compartment syndrome, Crush syndrome, Gluteal compartment syndrome, Thigh compartment
syndrome, Fasciotomy

Tomotaka Miura1

, Takahito Miyake1*, Hideshi Okada1

, Hideaki Oiwa1

, Yosuke Mizuno1

, Yuichiro Kitagawa1
,

Tetsuya Fukuta1

, Haruka Okamoto1

, Masato Shiba1

, Norihide Kanda1

, Takahiro Yoshida1

, Shozo Yoshida1 and

Shinji Ogura1

https://doi.org/10.1186/s12245-024-00675-5

2024

Peri Irawan

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