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Well-Limb Compartment Syndrome After Prolonged Lateral Decubitus PositioningA Report of Two Cases
Brett M. Cascio, MD1; Jacob M. Buchowski, MD1; Frank J. Frassica, MD1
1 c/o Elaine P. Henze, Medical Editor, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A672, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Sep 01;86(9):2038-2040
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External compression of a limb caused by casting, the use of military antishock trousers, or prolonged positioning secondary to drug overdose or during surgery may cause compartment syndrome in an otherwise healthy limb1. Well-leg compartment syndrome secondary to surgical positioning has been overwhelmingly associated with the lithotomy or hemilithotomy position2. A search of the literature revealed that there have been at least twenty-six cases of well-leg compartment syndrome associated with these positions, all of which occurred after at least two hours of operative time and most of which occurred after four and one-half hours2-8. In contrast to the lithotomy position, the lateral decubitus position has been reported to be associated with myonecrosis and sciatic nerve palsy but not compartment syndrome9-11. The leg represents one of the most common locations for acute compartment syndrome, whereas the thigh is a relatively rare location12. We report two cases of compartment syndrome that were associated with prolonged intraoperative lateral decubitus positioning, one of which involved the leg and one of which involved the thigh. To the best of our knowledge, these are the first two such cases that have been reported in the literature. Our patients were informed that data concerning these cases would be submitted for publication.
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