12/14/2023 0 Comments Lower extremity compartments![]() The anterior compartment pressure of the left leg was measured using a Stryker pressure monitor and was shown to be 5 mmHg. He remained afebrile throughout his hospital course. Vital signs at admission were pulse, 90 beats/min respirations, 20 breaths/min blood pressure, 147/84 mmHg and oral temperature, 36.8☌. The patient’s body mass index was 26.18 kg/m2. Plantar flexion and dorsiflexion were limited on the left side due to pain, but sensation was intact. On physical examination, minimal bilateral pedal edema was noted, left greater than right, with warmth and erythema extending to the ankle. The patient denied any intravenous drug use. The only pertinent positives in the patient’s social history were cocaine use, a 23 pack-year smoking history, and use of an over-the-counter weightlifting supplement that contains creatine for the previous nine months. He had been seen in our ED for cellulitis of the dorsal left foot secondary to an open insect bite twice in the previous six-month period with resolution of infection after the last encounter. Case PresentationĪ 43 year old male with a history of hypertension and recurrent left leg cellulitis presented to the Emergency Department (ED) with a one-week history of left foot pain that progressed to involve his ankle and lower leg. We report an unusual case in which the only risk factors were a combination of cocaine and creatine use as well as exercise. Spontaneous bilateral compartment syndrome with an unknown etiology in the lower extremities is a rare presentation and can be difficult to diagnose. Additionally, there have been several reported cases of compartment syndrome in athletes taking creatine supplements reported. More rare reported causes of acute compartment syndrome include ruptured baker’s cyst, strenuous exercise, heroin abuse, and cocaine abuse. Some reported non-traumatic causes include prolonged operative positioning, alcohol intoxication, tissue reperfusion, methanol poisoning, statin therapy, viral myositis, bleeding disorders, and diabetes mellitus. ![]() While the most common cause of ACS in the lower extremity is tibial fracture, there are several reported cases due to non-traumatic causes. The anterior and lateral compartments of the leg are the most commonly affected compartments in the lower extremity, while the superficial and deep posterior compartments are rarely involved1. This increase in compartmental pressure leads to decreased capillary blood flow, local tissue ischemia, and tissue necrosis1. KeywordsĬompartment syndrome Pressure Fasciotomy Creatine LowerĪcute compartment syndrome (ACS) occurs when there is a pressure increase within a confined fascial compartment that results in decreased perfusion to the tissues within the compartmental space. A high index of suspicion and early surgical management is the key for preventing long term adverse sequelae of acute compartment syndrome. The diagnosis of compartment syndrome in the absence of traumatic causes is often delayed and leads to increased patient morbidity. DISCUSSION AND CONCLUSIONS: The pharmacokinetics of both creatine and cocaine might lead to increased fascial compartment pressures furthermore, the concurrent use of each substance can potentially cause and exacerbate developing compartment syndrome. Despite any clear causative factor, we suggest an etiology based on the unique combination of prolonged creatine supplement use, strenuous exercise, and cocaine use. CASE PRESENTATION: We report an unusual case of a 43-year-old man with acute bilateral deep posterior compartment syndrome of the legs with flexor hallucis longus myonecrosis. For commercial reuse, contact AbstractīACKGROUND: Bilateral non-traumatic compartment syndrome of the legs is an exceedingly rare presentation that requires emergent surgical intervention. ![]() This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. Idiopathic spontaneous bilateral leg compartment syndrome in a 43-year-old male. Louisiana State University Health Sciences Center,ġ901 Perdido Street, New Orleans, LA 70112,Ĭitation: Huson H, Fontenot T.
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