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Acute Compartment Syndrome of the Thigh Following Rupture of the Quadriceps TendonA Case Report
John A. KuriII, MD1; Gregory S. DiFelice, MD2
1 Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Green Medical Arts Pavilion, 6th Floor, 3400 Bainbridge Avenue, Bronx, NY 10467-2490. E-mail address: kurilama@yahoo.com
2 Department of Orthopaedic Surgery, Jacobi Medical Center, 1400 Pelham Parkway South, Suite 218J, Bronx, NY 10461. E-mail address: gdifelice@hotmail.com
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research for 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 Jacobi Medical Center, Bronx, New York

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Feb 01;88(2):418-420. doi: 10.2106/JBJS.D.03048
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Extract

Rupture of the quadriceps tendon is a serious injury and is most often seen in individuals older than forty years of age1,2. Most ruptures occur during an attempt to prevent falling; the quadriceps muscle contracts eccentrically against the force of body weight1,3. As knee flexion increases, the tendon's ultimate strength is exceeded, resulting in rupture. Once the tendon fails, the zone of injury may spread away from the tendon, resulting in rupture of the retinacula and possible injury to the local vascular structures. The following case report concerns an individual in whom an acute compartment syndrome developed in the thigh following rupture of the quadriceps tendon. The patient granted permission for submission of data concerning his case for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Andreas Naparus
    Posted on March 03, 2006
    Proof of Acute Compartment Syndrome Is Lacking
    The Princess Royal Hospital, Haywards Heath, West Sussex, England.

    To The Editor:

    We read with interest the article, "Acute Compartment Syndrome of the Thigh Following Rupture of the Quadriceps Tendon. A Case Report."(1) The authors describe the clinical and intraoperative findings in a sixty-six year old patient who had fallen and sustained a quadriceps rupture. We would like to make the following points:

    Acute compartment syndrome of the thigh is rare. Quadriceps rupture is common. Quadriceps rupture may be associated with a large, tense haematoma which is often very painful.(2) Physical signs of acute compartment syndrome include tightness of the involved compartment; pain with passive motion of the muscles passing through the compartment; weakness of these muscles; hypesthesia; paresthesia; and most importantly pain out of proportion to that expected with the injury(2). In the case the authors describe, there was no neurological dysfunction. The quadriceps rupture could have been entirely responsible for: the patient’s ‘moderate distress’; pain on moving the knee; and the retinacular tenderness and echymosis.

    Moreover, the authors report that the signs were confined to the distal half of the anterior compartment of the thigh. Compartment syndrome by definition should involve the entirety of at least one compartment.

    The authors’ diagnosis in this case appears to hinge on the measured compartment pressure of 50mmHg. However, the authors do not state how many readings were taken, and at which sites. We suggest that if the transducer was placed directly into a large, tense but discrete haematoma that was confined to the musculotendinous unit, this would also give a high reading. Did the authors obtain readings from the proximal (clinically normal) half of the compartment?

    We also suggest that the authors’ operative technique casts doubt upon the diagnosis of compartment syndrome. The standard operative technique for acute compartment syndrome of the thigh involves an incision which runs the full length of the compartment and, crucially, a fasciotomy(2). Figure 2 depicts an incision which is not dissimilar from that commonly employed for knee arthroplasty. In addition,no fasciotomy was performed.

    References:

    (1) Kuri JA II, DiFelice GS. Acute Compartment Syndrome of the Thigh Following Rupture of the Quadriceps Tendon. A Case Report. J. Bone Joint Surg. Am., Feb 2006; 88: 418 - 420.

    (2) Azar FM. Traumatic disorders. In: Canale ST, editor. Campbell's Operative Orthopaedics. 10th ed. Philadelphia: Mosby; 2003. p2474 .

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