Well leg compartment syndrome: a case report
Well leg compartment syndrome refers to the occurrence of compartment syndrome in an uninjured limb in the absence of an underlying systemic predisposing cause. The present case has been reported in the journal Trauma Case Reports.

A 53 years old farmer presented to hospital after being hit from his bicycle by a motor vehicle. He reportedly lost consciousness for approximately 3 min based on eyewitness reports. On presentation he complained of pain to the entire right lower limb, specifically the hip, thigh and leg, with an inability to weight bear.

Plain radiographs done revealed a pertrochonteric fracture of his right femur with ipsilateral femoral and tibial shaft fractures. Laboratory investigation on admission reavealed a haemoglobin of 8.6 g/dL. He was placed on calcaneal traction on his right side and was transfused to a haemoglobin of 10.2 g/dL. His preoperative period was complicated by a multi-resistant urinary tract infection, which was treated with culture directed antibiotics until a sterile culture was obtained.

On day 18 post his injuries operative fixation of his right hip, femur and tibia fractures were undertaken. His left lower limb was placed in the hemi-lithotomy position with the hip flexed, abducted, externally rotated and the knee flexed at 90°. He had interlocking nailing of his tibia and retrograde nailing of his femur done in the hemi-lithotomy position.

Intra-operatively his urine output exceeded 120 mls/h (adequate for his weight) whilst in the hemi-lithotomy position. The total operating time was six hours and fifteen minutes. During the final stage of fixation i.e. dynamic hip screw placement, the patient had a drastic fall in his urine output to < 25mls/h. The urine was noted to have a “pepsi” colour and urinalysis revealed a pH of 6.5.

Based on the fall in urine output and pepsi coloured urine with an acidic pH, the patient was presumptively diagnosed with rhabdomyolysis with acute myoglobinuria. During transfer of the patient from the fracture table to a stretcher his well leg was noted to be swollen and tense. A diagnosis of well leg compartment syndrome was made. The limb was kept at the level of the heart and supplemental oxygen commenced. A four compartment fasciotomy was done.

He responded partially with the aforementioned treatment with improvements in his laboratory parameters. Day 12 post-operative the patient started on haemodialysis three times per week until his electrolytes, BUN and creatinine normalized on Day 25 post operative. Clinically, the well leg had neurological deficits in the post-operative period with absent power at the ankles and hypoesthesia in the L5/S1 distribution. This improved steadily up to his discharge on post-operative day 37.

On last out-patient clinic review (8 months post-op), the patient has had almost full recovery of function in his left lower limb with 5- power in all groups and return of sensation to the L5/S1 dermatome. His tibial and femoral fractures were healed.

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