Again, no refernces I'm afraid but will anecdotes do?
Couple of years ago, saw a patient one morning with leg pain. Previous
day had taken part in a Rugby match-few knocks but felt fine. Remembered
getting drunk at the post match party and limping home in the early
hours. Couldn't remember much else until woken in the morning with
severe leg pain-max 12 hours after rugby match.
X-ray of lower leg normal but when asked to elevate leg+severe
pain. Withhinsight examination-leg did look subtly swollen over
tibial anterior compartment but no
bruising. Referred to disbelieving orthopod and 6 hours later diagnosis
confirmed following pressure monitoring and subsequent
fasciotomy. The actual cause was never really pinpointed given that
alcohol had blurred any recollection by the patient. Since referred a
couple of other possibles, but diagnosis
shown not to be compartment syndrome. The only lesson I've learnt that
it is very difficult to diagnose and luck played a large part here. My
heightened suspiscion for it since has meant that a couple of patients
have ended up being admitted and investigated when all they've had
ultimately is simple bruising etc
Francis Andrews FFAEM
Lecturer in Intensive Care Medicine, Liverpool
On Thu, 14 Dec 2000, Ruth Brown wrote:
>We have a difficult issue of a compartment syndrome which was diagnosed
>very late. I would be interested to know if anyone has any reference for
>good quality evidence to answer the following -
> WHat proportion of compartment syndromes occur in non fractured legs
> How long after the initial injury does the "average" compartment syndrome
>present, ie how long can it take for the pressure to become critical
>
>WOuld be grateful for any experienced views or references.
>RUth
>
>Ruth Brown FRCS FFAEM
>Consultant in Emergency Medicine,
>King's College Hospital, London UK
>
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