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A fit and healthy 36-year-old man presented to the emergency department of a district general hospital, 20 min after sustaining single stab wounds to the anterior aspect of both thighs. Vital signs were normal and stable on admission, and external bleeding had been controlled with pressure dressings; however, he complained of severe pain in his right thigh which was not controlled with opiate analgesia. On examination he had a 1 inch (2.5 cm) incised wound in the mid anterior thigh. Bleeding had stopped but his quadriceps was tense and severe pain prevented any active or passive knee movement. Distal neurovascular examination was normal and the pain did not improve with removal of the pressure dressing. A clinical diagnosis of compartment syndrome was made and the patient proceeded to the operating theatre. In theatre a line transducer measured right anterior thigh compartment pressure at 50 mm Hg with a diastolic blood pressure of 40 mm Hg. An anterior compartment fasciotomy was performed and dusky coloured but viable quadriceps bulged immediately through the incision. A large haematoma was evacuated and a quadriceps tear repaired. The wound was left open and delayed closure was performed 3 days later. The patient regained full functional use of the limb.
DISCUSSION
The most important factor in the development of compartment syndrome is reduced muscle perfusion, caused by the...