Case Report
Version 1
Preserved in Portico This version is not peer-reviewed
Painless Compartment Syndrome
Version 1
: Received: 15 December 2022 / Approved: 19 December 2022 / Online: 19 December 2022 (07:24:34 CET)
How to cite: Shpigelman, A.; Maman, D.; Khalil Hanna, F.; Hakim, J.; Vodovozov, D.; Bernfeld, B. Painless Compartment Syndrome. Preprints 2022, 2022120327. https://doi.org/10.20944/preprints202212.0327.v1 Shpigelman, A.; Maman, D.; Khalil Hanna, F.; Hakim, J.; Vodovozov, D.; Bernfeld, B. Painless Compartment Syndrome. Preprints 2022, 2022120327. https://doi.org/10.20944/preprints202212.0327.v1
Abstract
Introduction: Acute compartment syndrome (ACS) is a surgical emergency that requires urgent intervention in order to prevent permanent structural damage and irreversible functional disability. The diagnosis of ACS depends on a high index of suspicion, relying on the following diagnostic criteria commonly known as the 5 Ps; Pain, Paresthesia, Paralysis, Pallor, and Pulse-lessness. When the diagnosis is uncertain, intracompartmental pressure greater than 30 mmHg is suggestive of ACS. Case Presentation: We report a case of an underdiagnosed ACS, with a lack of classical presentation in a thirty-seven-years-old male patient with a history of myopathy. The patient was admitted to the emergency room due to direct trauma to his right hip, without a significant Visual Analogue Score. On his hip radiograph a subtrochanteric fracture of the right femur was demonstrated. An additional masked ipsilateral subcapital fracture was detected during the operation. The diagnosis of ACS was made during the operation while relying on the clinical appearance of the thigh and the clinical findings during surgery. Fasciotomies were performed, and open reduction with internal fixation via Proximal Femoral Nail was done. The diagnosis of ACS was confirmed later on, by the biopsy results. Conclusion: This case suggests that myopathy can mask the classical presentation of ACS. Furthermore, the extent of pain complaints and accompanying paresthesia cannot be relied on in this regard and other clinical features should be considered in order to diagnose ACS.
Keywords
compartment syndrome; painless; myopathy; fasciotomy; subtrochanteric fracture
Subject
Medicine and Pharmacology, Emergency Medicine
Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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