Compartment syndrome of the thigh with sciatic nerve palsy

Acute compartment syndrome of the thigh has been infrequently reported in t he literature. Closed femoral fractures and blunt soft tissue trauma are th e main causes of this injury. The multiple injured patient in this case rep ort developed a compartment syndrome of the thigh after intramedullary nail ing of a comminuted fracture of the femur. Fasciotomy was performed two day s after surgery because of extense swelling of the thigh in the ventilated and sedated patient. Sciatic and femoral nerve palsy was recognized after e xtubation of the patient nine days after the injury. During the following w eeks the paresis of the femoral nerve recovered but neither motor nor senso ry function of the sciatic nerve could be demonstrated. Therefore an operat ive revision of the sciatic nerve was performed eighteen weeks after trauma . Mo direct nerve injury could be detected but there were adhesions around the nerve as a sign of compression neuropathy caused by the compartment syn drome. The tibial component of the sciatic nerve showed a complete recovery within the next months but there was a persisting peroneal nerve palsy. Co nclusion: Early clinical symptoms of a compartment syndrome like pain, pare sthesia and paresis can not be ascertained in a ventilated and sedated pati ent. Tense swelling of the muscles is often the only detectable sign. Frequ ent measurements of compartment pressure should be done in these patients. We suggest early decompressive fasciotomy because the morbidity caused by f asciotomy in a borderline compartment syndrome is far outweighed by the mor bidity that accompanies an undiagnosed untreated compartment syndrome with possible nerve palsy.