Compartment syndrome after serial casting in spastic diplegic cerebral palsy: a case report

We present the case of a 24-year-old woman with spastic diplegic cerebral palsy who developed left lower extremity compartment syndrome after serial casting to treat an equinus contracture. To our knowledge, this represents the first case of compartment syndrome that has occurred from cast application to treat a deformity. The cast was the second placed in the treatment series and was removed 18 hours later because of increased pain. The clinical picture progressed despite the cast being removed. Accordingly, the patient presented to the emergency department with uncontrollable pain and a peroneal nerve deficit. Compartment pressures were measured in the anterior, lateral, superficial, and deep posterior compartments and were 80, 56, 31, and 90 mmHg, respectively. She required 4-compartment fasciotomy, eventual skin grafting of her lateral wound, and late gastrocnemius lengthening for recurrent equinus contracture. The purpose of this report is to alert clinicians to the potential for compartment syndrome to occur as a result of serial casting applied to correct deformity.