[The "well-leg" syndrome: calf compartment after lithotomy position]

The lower leg compartment syndrome is in most cases a post-traumatic soft tissue complication. Nevertheless, it can also occur in a primarily not injured calf, due to external muscle compression during lithotomy positioning. This complication is seen rarely after gynaecological, urological or abdominal operations performed in the Lloyd-Davis position.

We present a case of calf compartment after prolonged lithotomy position of the uninjured leg during the nailing of a femur shaft fracture.

Postoperatively a diffuse turgor of the healthy calf was seen. The compartment pressures were elevated and the enzyme creatine kinase was elevated up to 3000 U/l. After dermatofasciotomy the enzyme level normalised, but in the further course we had to resect the necrotic peroneal muscle compartment.

During operative procedures at the coxal femur, it is necessary to deposit the other leg in the lithotomy postion. By this means, the compartment pressures can increase in the calf muscles to critical values. Together with operation times longer than 4 hours and a high ponderosity a bedding compartment can develop. As it is in the assumed "healthy" leg, this syndrome can be overseen, especially in sedated patients. It has to be considered with high creatine kinase levels and the typical risk factors. If a compartment syndrome is suspected, we recommend early dermatofasciotomy, as this is a low-risk and low-complication operation, in comparison to a later performed compartment decompression. By extending both legs, especially in risky patients, the surgeon can avoid this dangerous complication.