Case Study
European Journal of Trauma and Emergency Surgery
Acute Gluteal and Thigh Compartment Syndrome following Pelvic Fracture and Superior Gluteal Artery Bleed A Case Report and Review of the Literature Matthew J. Gee, Amit Tolat, Joydeep Sinha1
Abstract Injury to the superior gluteal artery as a result of pelvic fracture is well recognized. Superior gluteal artery bleed leading to gluteal compartment syndrome without fracture of the pelvis has been reported but is extremely rare. Similarly, acute compartment syndrome of the thigh is rare. As far as is known, no previous case has been reported where a combination of pelvic fracture and superior gluteal artery bleed has led to acute gluteal and thigh compartment syndrome. We report on such a patient who developed these complications and highlight the importance of early detection, which may be difficult in an unconscious or comatose patient. Key Words General trauma Æ Pelvic Æ Pelvic fractures Vascular trauma
Æ
Eur J Trauma Emerg Surg 2007;33:188–191 DOI 10.1007/s00068-006-6015-3
Introduction Injury to the superior gluteal artery as a result of pelvic fracture is well recognized [1, 2]. Superior gluteal artery bleed leading to gluteal compartment syndrome without fracture of the pelvis has been reported but is extremely rare [3]. Similarly, acute compartment syndrome of the thigh is rare [4–6]. As far as is known, no previous case
1
has been reported where a combination of pelvic fracture and superior gluteal artery bleed has led to acute gluteal and thigh compartment syndrome. We report on such a patient who developed these complications and highlight the importance of early detection, which may be difficult in an unconscious or comatose patient. Case Report A 32-year-old cyclist on holiday from the Canary Isles was struck on the right flank by a turning London bus. He was transferred to the Accident and Emergency Department at our center. His GCS at the scene was 4/15 but by the time he reached hospital it was 15/15, and he was cooperative and obeying commands. ATLS guidelines were adhered to. His airway was patent, his c-spine immobilized and his chest was clear. His blood pressure at the time of admission was 90/43 mmHg and labile with a regular pulse rate of 96 beats/min. The blood pressure initially improved with fluid resuscitation but remained labile despite further transfusions of crystalloid and packed red cells. Physical examination revealed a tender abdomen and pelvis which felt unstable when stressed, particularly on the right side. External abrasions over this site and hematoma over the lower lumbar spine were observed. There was no external bruising to the right buttock, thigh area or perineum and per rectal examination was normal. The right leg was painful to move. Given the history and clinical findings a pelvis wrap
Department of Trauma and Orthopaedics, King’s College Hospital, London, UK.
Received: January 24, 2006; revision accepted: May 29, 2006; Published Online: April 4, 2007
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Eur J Trauma Emerg Surg 2007 Æ No. 2 Ó URBAN & VOGEL
Gee MJ, et al. Acute Gluteal and Thigh Compartment Syndrome
Figure 1. AP radiograph of the pelvis taken as part of the trauma series.
Figure 2. CT scan of the pelvis showing comminuted right sacral ala fracture.
was used in order to try and stabilize the pelvis and reduce blood loss. Pelvic radiograph showed a comminuted fracture of the right sacral ala, right superior pubic ramus and the left superior pubic ramus (Figure 1). (The X-rays also reveal the metal buckle of the external pelvic wrap). Computerized tomographic scans (CT) showed no intracranial or cervical spine injury but clearly demonstrated severe injuries to the pelvis. There was a large retroperitoneal bleed within the pelvis, a severely comminuted fracture of the right sacral ala and the body and posterior sacral elements with extension into the spinal canal and bony fragments within the right side of the sacral canal (Figure 2). There were also further extensive comminuted fractures of both the superior and inferior pubic rami bilaterally with extension into the anterior columns of the acetabulae bilaterally. Continued repeated infusion of crystalloid and transfusion of type and cross-matched packed red blood cells was necessary to support the patient’s blood pressure. The hemoglobin level on admission was 11.1 g/dl and it dropped to 7.9 g/dl. After infusion of 4 units of blood the hemoglobin level remained low at 6.1 g/dl. The patient also received platelets and fresh frozen plasma. Despite temporarily stabilizing the pelvis thereby reducing the raw surface area of bleeding, the blood pressure could not be maintained without the continued administration of blood products. Arterial blood gases performed during this period revealed a profound metabolic acidosis with a pH of 7.208 and a base excess of –11.1. The lactate was 4.5. It was clear that there was a substantial ongoing hemorrhage and an arterial angiogram was therefore performed. This
revealed a right superior gluteal artery bleed and a subsequent embolization of the right internal iliac artery was carried out using vascular coils (Figures 3, 4). The patient’s blood pressure stabilized and he was transferred to the Intensive Therapy Unit (ITU), and then intubated and ventilated. During the course of the next 6 h the patient’s abdominal pressures began to rise significantly and he was also noted to have a swollen tense right thigh and lower buttock. His leg had also become discolored and the distal pulses were not palpable. Neurological examination was not possible. A proximal thigh compartment syndrome was suspected. The patient underwent a laparotomy and was found to have a length of ischemic small bowel which was resected and his abdomen was packed and left open. Fasciotomy of the right thigh was performed through a mid-lateral longitudinal incision that began proximally at the gluteal thigh junction and extended distally for 15–20 cm. The muscles bulged out through the incision and a large amount of hematoma with clots was removed from underneath the fascia lata (approximately 1 l). Vastus lateralis, rectus femoris and biceps femoris all appeared pink and healthy. The hematoma appeared to extend down from the groin and gluteal region, and there was a large posterior fascial defect that admitted the surgeon’s hand, allowing him to reach the gluteal muscles. The incision was extended proximally to fully evacuate these clots (additional 1.5–2 l). This would indicate a proximal source of bleeding. The gluteal muscles did not appear healthy. The wound was irrigated with normal saline and packed open with gauze dressings.
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Gee MJ, et al. Acute Gluteal and Thigh Compartment Syndrome
in the L5/S1 distribution. He has been lost to follow-up as he went back to the Canary Isles.
Figure 3. Angiogram showing superior gluteal artery bleed.
Figure 4. Angiogram post deployment of vascular coils.
Advice from the nearest Trauma Center specializing in pelvic fractures was sought the next day once the patient’s condition had been stabilized. Given the patient’s medical condition and the fact that he had open wounds both in the abdomen and thigh, they advised conservative treatment for his pelvic fractures. A vacuum dressing was used to aid wound closure and the patient underwent successful skin grafting to the area 10 weeks later. At the time of discharge from the rehabilitation ward 5 months after the initial injury the patient was able to walk with the aid of one stick and an AFO on the right leg for up to 40 min. He had marked muscle weakness in the right lower leg and severe sensory loss
190
Discussion Compartment syndromes generally occur in those tissues that are contained within fascial compartments or other limiting boundaries, for example plaster casts. Increases in compartment pressures to critical levels lead to compression of the venous system and reduce arterial inflow, resulting in tissue ischemia and cellular damage. Endothelial dysfunction leads to fluid and protein leakage, which contributes to raising the pressures higher still. Raised intracompartmental pressures and its resultant ischemia lead to neuromuscular compromise with muscle necrosis occurring within 4–6 h [7]. Anatomically, the gluteal region is distinct from that of the thigh. The gluteal region has been described as being made up of three compartments, each separated by their individual surrounding nondistensible boundaries: gluteus maximus, gluteus medius-minimus and tensor fascia lata compartments. However, it is the gluteal fascia and aponeurosis anchored to the ilium, sacrum, coccyx, and iliotibial tract that confine these compartments to their nonexpansible spaces [8]. The thigh is also organized into three main compartments (anterior, medial, and posterior) all of which are enveloped in one fascial layer, the fascia lata. This constitutes one large compartment, which is septate. Documented causes of gluteal compartment syndromes have included open and endovascular repair of abdominal aortic aneurysms [9–11], hip replacement surgery [12], epidural analgesia [13], intramuscular gluteal injection [14] and drug-induced coma and overdose [15]. It has been reported following trauma but only one such report has been found in the literature in which it was secondary to a rupture of the superior gluteal artery [3] and in this case there was no associated pelvic fracture. Gluteal compartment syndrome is hence rare and this may be related to the size of the compartment and difficulty in diagnosis. Compartment syndrome of the thigh is also uncommon. Its association with pelvic fracture has not been documented although it has been associated with femoral fractures [4], arterial injuries in the thigh following blunt trauma [16], anticoagulation [5] and muscle strain [6]. To our knowledge, no previous case has been reported where a combination of pelvic fracture and superior gluteal artery bleed has led to either an acute gluteal and/or thigh compartment syndrome.
Eur J Trauma Emerg Surg 2007 Æ No. 2 Ó URBAN & VOGEL
Gee MJ, et al. Acute Gluteal and Thigh Compartment Syndrome
References 1.
Figure 5. CT scan of the pelvis highlighting hematoma extruding through greater sciatic notch.
In our case we were faced with a combination of problems. Firstly, the patient was intubated and ventilated soon after presentation to the accident and emergency department. This made clinical assessment difficult and hence only when circulatory changes appeared, (cool, pulseless limb), was the delayed diagnosis made and a decompression performed. Secondly, during surgery it became obvious that the compartment syndrome in the right thigh was in fact secondary to a large collection of blood and clots that had originated higher up i.e. a likely right gluteal compartment syndrome. Further clots (up to 2 l) were evacuated from the pelvic and gluteal region through a defect in the fascia and by extending the skin incision proximally. A large retroperitoneal hematoma had formed from a combination of the superior gluteal artery bleed, the comminuted sacral fracture, and the other associated injuries around the area. The superior gluteal artery is known to be vulnerable in the region of the sciatic notch [3]. As a result of the huge pressures in the retroperitoneum, the hematoma was forced out through the subfascial planes and through the greater sciatic notch into the gluteal region and thereafter into the proximal thigh. A CT scan performed after the fasciotomy clearly demonstrates this (Figure 5). Gas is evident within the hematoma and soft tissues due to the open wound. We report this case because of its association with a pelvic fracture and the need to consider gluteal and thigh compartment syndromes as a complication of retroperitoneal bleeding which was due, in our case, to a pelvic fracture and a superior gluteal artery injury. It highlights the importance of early detection, which may prove potentially difficult in an unconscious or comatose patient.
Eur J Trauma Emerg Surg 2007 Æ No. 2 Ó URBAN & VOGEL
Flemming WH, Bowen JC III. Control of haemorrhage in pelvic crush injuries. J Trauma 1977;17:323–4. 2. Brown JJ, Greene FL, McMillin RD. Vascular injuries associated with pelvic fractures. Am Surg 1984;50:150–4. 3. Brumback RJ. Traumatic rupture of the superior gluteal artery, without fracture of the pelvis, causing compartment syndrome of the buttock. J Bone Joint Surg 1990;72A:134. 4. Tarlow SD, Achterman J, Hayhurst J, Ovadia DN. Acute compartment syndrome in the thigh complicating fracture of the femur. J Bone Joint Surg 1986;68A:1439–43. 5. Reuben A, Clouting E. Compartment syndrome after thrombolysis for acute myocardial infarction. Emerg Med 2005;22:77. 6. Barnes MR, Harper WM, Tomson CR, Williams NM. Gluteal compartment syndrome following drug overdose. Injury 1992;23:274–5. 7. Mabee JR, Bostwick TL. Pathophysiology and mechanisms of compartment syndrome. Orthop Rev 1993;22:175. 8. Bleicher RJ, Sherman HF, Latenser BA. Bilateral gluteal compartment syndrome. J Trauma 1997;42:118. 9. Ishibashi H, Ohta T, Hosaka M, Sugimoto I, Kawanishi J, Yamada T. Gluteal compartment syndrome after abdominal aortic aneurysm repair. Vasa 2004;33:89–91. 10. Maldonado TS, Rockman CB, Riles E, Douglas D, Adelman MA, Jacobowitz GR, Gagne PJ, Nalbandian MN, Cayne NS, Lamparello PJ, Salzberg SS, Riles TS. Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004;40:703–9. 11. Pua BB, Cayne NS, Dobryansky M, Jacobowitz GR. Bilateral gluteal compartment syndrome after elective unilateral hypogastric artery ligation and revascularization of the contrlateral hypogastric artery during open abdominal aortic aneurysm repair. J Vasc Surg 2005;41:337–9. 12. Pai VS. Compartment syndrome of the buttock following a total hip arthroplasty. J Arthroplasty 1996;11:609–10. 13. Kontrobarsky Y, Love J. Gluteal compartment syndrome following epidural analgesic infusion with motor blockade. Anaesth Intensive Care 1997;25:696–8. 14. Kuhle JW, Swoboda B. Gluteal compartment syndrome after intramuscular gluteal injection. Z Ortop Ihre Grenzgeb 1999;137:366–7. 15. Burns BJ, Sproule J, Smyth H. Acute compartment syndrome of the anterior thigh following quadriceps strain in a footballer. Br J Sports Med 2004;38:218–20. 16. Suzuki T, Moirmura N, Kawai K, Sugiyama M. Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma. Injury 2005;36:151.
Address for Correspondence Matthew J. Gee, MBBS, BSC, MRCS Department of Trauma and Orthopaedics King’s College Hospital London SE5 9RS UK Phone (+44/20) 3299-9000, Fax -3497 e-mail: [email protected]
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European Journal of Trauma and Emergency Surgery
Acute Gluteal and Thigh Compartment Syndrome following Pelvic Fracture and Superior Gluteal Artery Bleed A Case Report and Review of the Literature Matthew J. Gee, Amit Tolat, Joydeep Sinha1
Abstract Injury to the superior gluteal artery as a result of pelvic fracture is well recognized. Superior gluteal artery bleed leading to gluteal compartment syndrome without fracture of the pelvis has been reported but is extremely rare. Similarly, acute compartment syndrome of the thigh is rare. As far as is known, no previous case has been reported where a combination of pelvic fracture and superior gluteal artery bleed has led to acute gluteal and thigh compartment syndrome. We report on such a patient who developed these complications and highlight the importance of early detection, which may be difficult in an unconscious or comatose patient. Key Words General trauma Æ Pelvic Æ Pelvic fractures Vascular trauma
Æ
Eur J Trauma Emerg Surg 2007;33:188–191 DOI 10.1007/s00068-006-6015-3
Introduction Injury to the superior gluteal artery as a result of pelvic fracture is well recognized [1, 2]. Superior gluteal artery bleed leading to gluteal compartment syndrome without fracture of the pelvis has been reported but is extremely rare [3]. Similarly, acute compartment syndrome of the thigh is rare [4–6]. As far as is known, no previous case
1
has been reported where a combination of pelvic fracture and superior gluteal artery bleed has led to acute gluteal and thigh compartment syndrome. We report on such a patient who developed these complications and highlight the importance of early detection, which may be difficult in an unconscious or comatose patient. Case Report A 32-year-old cyclist on holiday from the Canary Isles was struck on the right flank by a turning London bus. He was transferred to the Accident and Emergency Department at our center. His GCS at the scene was 4/15 but by the time he reached hospital it was 15/15, and he was cooperative and obeying commands. ATLS guidelines were adhered to. His airway was patent, his c-spine immobilized and his chest was clear. His blood pressure at the time of admission was 90/43 mmHg and labile with a regular pulse rate of 96 beats/min. The blood pressure initially improved with fluid resuscitation but remained labile despite further transfusions of crystalloid and packed red cells. Physical examination revealed a tender abdomen and pelvis which felt unstable when stressed, particularly on the right side. External abrasions over this site and hematoma over the lower lumbar spine were observed. There was no external bruising to the right buttock, thigh area or perineum and per rectal examination was normal. The right leg was painful to move. Given the history and clinical findings a pelvis wrap
Department of Trauma and Orthopaedics, King’s College Hospital, London, UK.
Received: January 24, 2006; revision accepted: May 29, 2006; Published Online: April 4, 2007
188
Eur J Trauma Emerg Surg 2007 Æ No. 2 Ó URBAN & VOGEL
Gee MJ, et al. Acute Gluteal and Thigh Compartment Syndrome
Figure 1. AP radiograph of the pelvis taken as part of the trauma series.
Figure 2. CT scan of the pelvis showing comminuted right sacral ala fracture.
was used in order to try and stabilize the pelvis and reduce blood loss. Pelvic radiograph showed a comminuted fracture of the right sacral ala, right superior pubic ramus and the left superior pubic ramus (Figure 1). (The X-rays also reveal the metal buckle of the external pelvic wrap). Computerized tomographic scans (CT) showed no intracranial or cervical spine injury but clearly demonstrated severe injuries to the pelvis. There was a large retroperitoneal bleed within the pelvis, a severely comminuted fracture of the right sacral ala and the body and posterior sacral elements with extension into the spinal canal and bony fragments within the right side of the sacral canal (Figure 2). There were also further extensive comminuted fractures of both the superior and inferior pubic rami bilaterally with extension into the anterior columns of the acetabulae bilaterally. Continued repeated infusion of crystalloid and transfusion of type and cross-matched packed red blood cells was necessary to support the patient’s blood pressure. The hemoglobin level on admission was 11.1 g/dl and it dropped to 7.9 g/dl. After infusion of 4 units of blood the hemoglobin level remained low at 6.1 g/dl. The patient also received platelets and fresh frozen plasma. Despite temporarily stabilizing the pelvis thereby reducing the raw surface area of bleeding, the blood pressure could not be maintained without the continued administration of blood products. Arterial blood gases performed during this period revealed a profound metabolic acidosis with a pH of 7.208 and a base excess of –11.1. The lactate was 4.5. It was clear that there was a substantial ongoing hemorrhage and an arterial angiogram was therefore performed. This
revealed a right superior gluteal artery bleed and a subsequent embolization of the right internal iliac artery was carried out using vascular coils (Figures 3, 4). The patient’s blood pressure stabilized and he was transferred to the Intensive Therapy Unit (ITU), and then intubated and ventilated. During the course of the next 6 h the patient’s abdominal pressures began to rise significantly and he was also noted to have a swollen tense right thigh and lower buttock. His leg had also become discolored and the distal pulses were not palpable. Neurological examination was not possible. A proximal thigh compartment syndrome was suspected. The patient underwent a laparotomy and was found to have a length of ischemic small bowel which was resected and his abdomen was packed and left open. Fasciotomy of the right thigh was performed through a mid-lateral longitudinal incision that began proximally at the gluteal thigh junction and extended distally for 15–20 cm. The muscles bulged out through the incision and a large amount of hematoma with clots was removed from underneath the fascia lata (approximately 1 l). Vastus lateralis, rectus femoris and biceps femoris all appeared pink and healthy. The hematoma appeared to extend down from the groin and gluteal region, and there was a large posterior fascial defect that admitted the surgeon’s hand, allowing him to reach the gluteal muscles. The incision was extended proximally to fully evacuate these clots (additional 1.5–2 l). This would indicate a proximal source of bleeding. The gluteal muscles did not appear healthy. The wound was irrigated with normal saline and packed open with gauze dressings.
Eur J Trauma Emerg Surg 2007 Æ No. 2 Ó URBAN & VOGEL
189
Gee MJ, et al. Acute Gluteal and Thigh Compartment Syndrome
in the L5/S1 distribution. He has been lost to follow-up as he went back to the Canary Isles.
Figure 3. Angiogram showing superior gluteal artery bleed.
Figure 4. Angiogram post deployment of vascular coils.
Advice from the nearest Trauma Center specializing in pelvic fractures was sought the next day once the patient’s condition had been stabilized. Given the patient’s medical condition and the fact that he had open wounds both in the abdomen and thigh, they advised conservative treatment for his pelvic fractures. A vacuum dressing was used to aid wound closure and the patient underwent successful skin grafting to the area 10 weeks later. At the time of discharge from the rehabilitation ward 5 months after the initial injury the patient was able to walk with the aid of one stick and an AFO on the right leg for up to 40 min. He had marked muscle weakness in the right lower leg and severe sensory loss
190
Discussion Compartment syndromes generally occur in those tissues that are contained within fascial compartments or other limiting boundaries, for example plaster casts. Increases in compartment pressures to critical levels lead to compression of the venous system and reduce arterial inflow, resulting in tissue ischemia and cellular damage. Endothelial dysfunction leads to fluid and protein leakage, which contributes to raising the pressures higher still. Raised intracompartmental pressures and its resultant ischemia lead to neuromuscular compromise with muscle necrosis occurring within 4–6 h [7]. Anatomically, the gluteal region is distinct from that of the thigh. The gluteal region has been described as being made up of three compartments, each separated by their individual surrounding nondistensible boundaries: gluteus maximus, gluteus medius-minimus and tensor fascia lata compartments. However, it is the gluteal fascia and aponeurosis anchored to the ilium, sacrum, coccyx, and iliotibial tract that confine these compartments to their nonexpansible spaces [8]. The thigh is also organized into three main compartments (anterior, medial, and posterior) all of which are enveloped in one fascial layer, the fascia lata. This constitutes one large compartment, which is septate. Documented causes of gluteal compartment syndromes have included open and endovascular repair of abdominal aortic aneurysms [9–11], hip replacement surgery [12], epidural analgesia [13], intramuscular gluteal injection [14] and drug-induced coma and overdose [15]. It has been reported following trauma but only one such report has been found in the literature in which it was secondary to a rupture of the superior gluteal artery [3] and in this case there was no associated pelvic fracture. Gluteal compartment syndrome is hence rare and this may be related to the size of the compartment and difficulty in diagnosis. Compartment syndrome of the thigh is also uncommon. Its association with pelvic fracture has not been documented although it has been associated with femoral fractures [4], arterial injuries in the thigh following blunt trauma [16], anticoagulation [5] and muscle strain [6]. To our knowledge, no previous case has been reported where a combination of pelvic fracture and superior gluteal artery bleed has led to either an acute gluteal and/or thigh compartment syndrome.
Eur J Trauma Emerg Surg 2007 Æ No. 2 Ó URBAN & VOGEL
Gee MJ, et al. Acute Gluteal and Thigh Compartment Syndrome
References 1.
Figure 5. CT scan of the pelvis highlighting hematoma extruding through greater sciatic notch.
In our case we were faced with a combination of problems. Firstly, the patient was intubated and ventilated soon after presentation to the accident and emergency department. This made clinical assessment difficult and hence only when circulatory changes appeared, (cool, pulseless limb), was the delayed diagnosis made and a decompression performed. Secondly, during surgery it became obvious that the compartment syndrome in the right thigh was in fact secondary to a large collection of blood and clots that had originated higher up i.e. a likely right gluteal compartment syndrome. Further clots (up to 2 l) were evacuated from the pelvic and gluteal region through a defect in the fascia and by extending the skin incision proximally. A large retroperitoneal hematoma had formed from a combination of the superior gluteal artery bleed, the comminuted sacral fracture, and the other associated injuries around the area. The superior gluteal artery is known to be vulnerable in the region of the sciatic notch [3]. As a result of the huge pressures in the retroperitoneum, the hematoma was forced out through the subfascial planes and through the greater sciatic notch into the gluteal region and thereafter into the proximal thigh. A CT scan performed after the fasciotomy clearly demonstrates this (Figure 5). Gas is evident within the hematoma and soft tissues due to the open wound. We report this case because of its association with a pelvic fracture and the need to consider gluteal and thigh compartment syndromes as a complication of retroperitoneal bleeding which was due, in our case, to a pelvic fracture and a superior gluteal artery injury. It highlights the importance of early detection, which may prove potentially difficult in an unconscious or comatose patient.
Eur J Trauma Emerg Surg 2007 Æ No. 2 Ó URBAN & VOGEL
Flemming WH, Bowen JC III. Control of haemorrhage in pelvic crush injuries. J Trauma 1977;17:323–4. 2. Brown JJ, Greene FL, McMillin RD. Vascular injuries associated with pelvic fractures. Am Surg 1984;50:150–4. 3. Brumback RJ. Traumatic rupture of the superior gluteal artery, without fracture of the pelvis, causing compartment syndrome of the buttock. J Bone Joint Surg 1990;72A:134. 4. Tarlow SD, Achterman J, Hayhurst J, Ovadia DN. Acute compartment syndrome in the thigh complicating fracture of the femur. J Bone Joint Surg 1986;68A:1439–43. 5. Reuben A, Clouting E. Compartment syndrome after thrombolysis for acute myocardial infarction. Emerg Med 2005;22:77. 6. Barnes MR, Harper WM, Tomson CR, Williams NM. Gluteal compartment syndrome following drug overdose. Injury 1992;23:274–5. 7. Mabee JR, Bostwick TL. Pathophysiology and mechanisms of compartment syndrome. Orthop Rev 1993;22:175. 8. Bleicher RJ, Sherman HF, Latenser BA. Bilateral gluteal compartment syndrome. J Trauma 1997;42:118. 9. Ishibashi H, Ohta T, Hosaka M, Sugimoto I, Kawanishi J, Yamada T. Gluteal compartment syndrome after abdominal aortic aneurysm repair. Vasa 2004;33:89–91. 10. Maldonado TS, Rockman CB, Riles E, Douglas D, Adelman MA, Jacobowitz GR, Gagne PJ, Nalbandian MN, Cayne NS, Lamparello PJ, Salzberg SS, Riles TS. Ischemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004;40:703–9. 11. Pua BB, Cayne NS, Dobryansky M, Jacobowitz GR. Bilateral gluteal compartment syndrome after elective unilateral hypogastric artery ligation and revascularization of the contrlateral hypogastric artery during open abdominal aortic aneurysm repair. J Vasc Surg 2005;41:337–9. 12. Pai VS. Compartment syndrome of the buttock following a total hip arthroplasty. J Arthroplasty 1996;11:609–10. 13. Kontrobarsky Y, Love J. Gluteal compartment syndrome following epidural analgesic infusion with motor blockade. Anaesth Intensive Care 1997;25:696–8. 14. Kuhle JW, Swoboda B. Gluteal compartment syndrome after intramuscular gluteal injection. Z Ortop Ihre Grenzgeb 1999;137:366–7. 15. Burns BJ, Sproule J, Smyth H. Acute compartment syndrome of the anterior thigh following quadriceps strain in a footballer. Br J Sports Med 2004;38:218–20. 16. Suzuki T, Moirmura N, Kawai K, Sugiyama M. Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma. Injury 2005;36:151.
Address for Correspondence Matthew J. Gee, MBBS, BSC, MRCS Department of Trauma and Orthopaedics King’s College Hospital London SE5 9RS UK Phone (+44/20) 3299-9000, Fax -3497 e-mail: [email protected]
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