From the Guidelines
The thigh has three compartments that are prone to compartment syndrome: the anterior (front) compartment, the posterior (back) compartment, and the medial (inner) compartment. These compartments are at risk of developing compartment syndrome, a condition where increased pressure within the closed fascial spaces compromises blood flow and nerve function, leading to tissue ischemia and potential necrosis if not treated promptly 1. The anterior compartment is most commonly affected and contains the quadriceps muscles and femoral nerve, while the posterior compartment houses the hamstring muscles and sciatic nerve, and the medial compartment contains the adductor muscles. Symptoms of compartment syndrome include severe pain disproportionate to the injury, pain with passive stretching, paresthesia, and eventually paralysis and pulselessness. According to the most recent guidelines, definitive treatment requires fasciotomy to relieve the pressure, ideally within 6 hours of onset to prevent permanent muscle and nerve damage 1. Intracompartmental pressure measurements above 30 mmHg or within 30 mmHg of diastolic pressure typically indicate the need for surgical intervention 1. It is essential to monitor patients with severe limb trauma for compartment syndrome, as the clinical signs may be difficult to elicit, especially in obtunded or unco-operative patients 1. Key points to consider in the diagnosis and management of compartment syndrome include:
- Clinical signs such as pain, pain with passive stretching, paresthesia, and paralysis
- Intracompartmental pressure measurements
- The need for prompt fasciotomy to relieve pressure and prevent permanent damage
- The importance of monitoring patients with severe limb trauma for compartment syndrome.
From the Research
Compartments Prone to Compartment Syndrome
The thigh is composed of several compartments, and compartment syndrome can occur in any of these compartments. The compartments prone to compartment syndrome in the thigh are:
- Anterior compartment: This compartment contains the quadriceps femoris muscle and is prone to compartment syndrome, especially in athletes 2, 3.
- Other compartments: Although the studies provided do not specifically mention other compartments, it can be inferred that any compartment in the thigh can be prone to compartment syndrome, given the right circumstances.
Characteristics of Compartment Syndrome
Compartment syndrome is characterized by increased interstitial pressure within a closed osteofascial compartment, which impairs local circulation 4. This can occur after a severe injury, such as a fracture or crush injury, or after a relatively minor injury. The diagnosis of compartment syndrome is made on the basis of physical examination and repeated intracompartmental pressure (ICP) measures, with an ICP higher than 30 mmHg of diastolic blood pressure being significant of compartment syndrome 4.
Treatment of Compartment Syndrome
The treatment of compartment syndrome typically involves fasciotomy to release the affected compartment, which should be performed as early as possible to prevent irreversible ischemic damage to muscles and peripheral nerves 4, 5, 6. In some cases, conservative treatment may be considered, especially in selected young patients with isolated anterior compartment syndrome of the thigh 2. However, the decision to perform fasciotomy or conservative treatment should be made on a case-by-case basis, taking into account the individual patient's circumstances and the severity of the compartment syndrome.