Thigh Compartment Syndrome
Normal Anatomy
The thigh is composed of one bone, the femur, as well as large groups of muscles in the front, back, and inner sides of the thigh. Major nerves from the spinal cord run down the thigh into the leg. Major blood vessels that originate in the trunk run down the thigh and into the leg as well. The muscles, nerves, and blood vessels in the front, back, and inner part of the thigh are separated into compartments by thickened collagen tissue, called fascia.
Pathology
Compartment syndrome is an orthopedic emergency. Thigh compartment syndrome occurs when the pressure in the front, back, or inner thigh compartments rises above the blood pressure needed for the heart to pump blood to the thigh. When this occurs, the muscles and nerves within the compartment are at risk of dying with little or no chance of recovery. Thigh compartment syndrome usually occurs after some sort of thigh trauma such as a fall with or without a fracture. Patients may complain of increasing pain, pain out of proportion to the injury, an increase in pain medication requirements, numbness, tingling, or no symptoms at all. The thigh may feel tense, the patient may have pain with stretch of the muscles affected, there may be a loss of sensation in the thigh, a cool feeling of the skin, loss of pulses in the groin or back of the knee, or loss of function of the thigh muscles. Because the signs and symptoms can be variable, physicians must maintain a high index of suspicion if the patient’s complaints and injury history are consistent with a compartment syndrome.
Treatment
If a thigh compartment syndrome is diagnosed, it must be treated within 6 hours. The treatment consists of a trip to the operating room where the connective tissue (fascia) that surrounds and separates each compartment must be surgically released. This release relieves the pressure within the compartment and allows the muscles and nerves within the compartment to receive their required blood supply. The surgical wounds are often not sutured back immediately to allow for the skin and soft tissue to accommodate any swelling that occurred during the course of the surgery. The surgical wounds are then sutured back at a later a date. If they cannot be sutured back because of skin tightness, the use of a vacuum-assisted wound closure device may be used. Skin grafts may sometimes be needed to ultimately close the surgical wounds.