Delayed onset thigh compartment syndrome secondary to contusion

While thigh compartment syndrome is relatively uncommon, it can occur in various situations. Multiple reports document thigh contusions as a cause of acute compartment syndrome; however, compartment syndrome of the thigh presenting primarily in a delayed fashion secondary to a contusion has not been described. This article reports a case of thigh compartment syndrome. A 39-year-old man sustained a left thigh contusion while playing basketball. He continued to play and also worked at the office over the next 2 days. Fifty-two hours postinjury, he developed severe pain in the thigh after a long walk. Increased swelling of the thigh followed, with numbness in the anterolateral thigh and pain with knee motion. He presented 60 hours postinjury with a compartment syndrome, and a lateral decompressive fasciotomy of the thigh was performed 62 hours postinjury. The wound was closed after 5 days. Three months postoperatively, the patient returned to playing basketball with no deficits. Treatment of established compartment syndrome in such cases is controversial, with some reports recommending nonoperative management. Contusion-related compartment syndromes are frequently associated with intramuscular bleeding in the involved compartment, which may accumulate slowly or worsen with further activity. Guidelines regarding return to sports need to be established in individuals sustaining severe contusions during sports-related activities to prevent compartment syndrome. Any individual sustaining such an injury should be under surveillance for delayed onset symptoms or signs of this potentially devastating syndrome.