The Well Leg Compartment Syndrome in Orthopaedic Surgery - A Case Report with Review

Area of Science:

• Orthopaedic Surgery
• Trauma Surgery
• Vascular Surgery

Background:

• Patient positioning during surgery can lead to perioperative complications.
• Well leg compartment syndrome (WLCS) is a rare but serious complication, particularly in orthopaedic procedures.
• Improper positioning, especially in lithotomy, can cause damage to the unaffected limb.

Purpose of the Study:

• To highlight the risks and incidence of well leg compartment syndrome (WLCS) in orthopaedic surgery.
• To present a case of WLCS following femur fracture surgery.
• To review current literature and suggest preventative strategies for WLCS.

Main Methods:

• A literature search was conducted on PubMed using terms related to WLCS and orthopaedic surgery.
• 14 case reports were selected after extensive full-text review.
• A specific case of WLCS in a 63-year-old patient undergoing femur fracture surgery is detailed.

Main Results:

• WLCS is most frequently reported after femur intramedullary nail osteosynthesis in modified lithotomy position.
• Longer operating times (over 2 hours) are common in reported WLCS cases.
• Diagnosis timing varied from immediate postoperative to 3 days after surgery; fasciectomy was the common treatment.

Conclusions:

• Position-associated acute compartment syndrome is a rare orthopaedic complication.
• Risk factors include prolonged surgery, high BMI, blood loss, hypotension, and peripheral vascular disease.
• Careful positioning of the unaffected limb and awareness of risk factors are essential for prevention.