Are compartment syndromes seen in the thighs?

From the Guidelines

Compartment syndromes can occur in the thighs, although the provided guideline evidence primarily focuses on lower extremity peripheral artery disease and does not directly address thigh compartment syndromes. When considering the management of lower extremity peripheral artery disease, prophylactic fasciotomies at the time of revascularization or early in the presentation can avoid a later delay in diagnosis of compartment syndrome and devastating complications associated with this delayed diagnosis, as noted in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. However, this guideline does not specifically discuss compartment syndromes in the thighs. Key points to consider in the context of compartment syndromes include:

• The importance of early recognition and intervention to prevent permanent muscle necrosis, nerve damage, contractures, and limb loss
• The role of prophylactic fasciotomy in avoiding delayed diagnosis and complications, as seen in the management of lower extremity peripheral artery disease 1
• The need for diligent postacute wound care to mitigate wound complications and facilitate incisional closure, as discussed in the context of lower extremity peripheral artery disease management 1. Given the lack of direct evidence on thigh compartment syndromes in the provided guideline, it is essential to prioritize early recognition and intervention, as well as careful consideration of the risks and benefits of prophylactic fasciotomy, in the management of suspected compartment syndromes in the thighs.

From the Research

Compartment Syndromes in the Thighs

• Compartment syndrome in the thigh is an uncommon but potentially devastating condition that has been associated with multiple etiologies, mainly motor vehicle trauma, closed or open femur fractures, and vascular injuries 2.
• Exercise-induced acute compartment syndrome of the thigh is an uncommon entity, with a rare case of bilateral exercise-induced three-compartment syndrome of the thighs requiring fasciotomies reported in the literature 3.
• Thigh compartment syndrome is a surgical emergency with a risk of high morbidity and mortality rates, with the most common cause being blunt trauma (90%) 4.
• Compartment syndrome of the thigh can also occur due to closed blunt trauma without a femur fracture, although this is rare due to the increased compliance of the thigh to accommodate increased expansion from hematoma or third space fluid 5.
• The diagnosis of compartment syndrome in the thigh is characterized by unrelenting pain, swelling, and limited knee range of motion, with early diagnosis and appropriate emergency treatment crucial to avoiding serious and permanent complications 2, 5.

Causes and Treatment

• The causes of thigh compartment syndrome include motor vehicle accidents, motorcycle accidents, femur fractures, and other limb fractures, as well as renal, cardiovascular, and head insults 4.
• Treatment for thigh compartment syndrome typically involves fasciotomy, with 86% of fasciotomies performed through a single incision 4.
• Wound closure methods include delayed primary closure, split-thickness skin grafts, and primary wound closure, with neurological deficits being the most common complications 4.
• Rehabilitation after fasciotomy is extremely important in regaining extremity functions, with current approaches to compartment syndrome and rehabilitation principles following fasciotomy discussed in the literature 6.