Abstract
Introduction
For the osteosynthetic treatment of fractures of the femur and optimal exposure of
the fractured region including radiological fluoroscopy, it is often recommended to
carry out positioning on an extension table, with positioning of the contralateral
lower limb on a leg holder. It is not uncommon for this to result in peri- and postoperative
damage of varying severity as a result of patient positioning. Some cases of damage
due to improper positioning can be found in the literature in the context of urological,
general and gynaecological surgery. This is often associated with the responsible
surgical speciality, which often requires a lithotomy position and thus the bilateral
positioning of the healthy lower extremities. The aim of this article is to draw attention
to the well leg compartment syndrome (WLCS) of the unaffected side in orthopaedic
surgery, by presenting a case of our own and to point out particular risks on the
basis of a current literature review, as well as
to discuss procedural suggestions for prevention.
Material and Methods
A literature search was carried out using the online medical database “PubMed” (search
date 20.02.2025). After entering the search terms “Well leg compartment syndrome AND
orthopaedic surgery”, “Well leg compartment syndrome AND orthopaedics” and “Well leg
compartment syndrome AND hemilithotomy positioning”, a total of 175 search hits were
found. After removal of duplicates and an extended full-text search, a total of 14
case reports were selected and included in the current publication.
Case Report
This report describes a compartment syndrome of the lower leg of the positioned uninjured
limb (well leg compartment syndrome, WLCS) in a 63-year-old patient following prolonged
emergency intramedullary nail osteosynthesis of a complex femur fracture, with an
operating time of 8:12 h.
Results
In the literature, WLCS of the lower leg in orthopaedic surgery is found in most cases
after intramedullary nail osteosynthesis of the femur in patients positioned in modified
lithotomy. The operating time was over 2 h in most cases. The diagnosis of compartment
syndrome was made in a wide time window between immediately postoperatively and up
to 3 days after the operation. The treatment of choice in the majority of cases was
fasciectomy of all 4 compartments of the lower leg. No statement can be made about
other risk factors in the cases presented in the research – due to missing or limited
data.
Conclusion
Position-associated acute compartment syndrome in orthopaedic surgery is a rarely
described complication. Risk factors include a long operating time, increased BMI,
increased blood loss, low intraoperative blood pressure and peripheral vascular disease.
The uninjured leg should be correctly positioned in the lithotomy position intraoperatively
(90° flexion in hip and knee) and be as little as possible in the case of known risk
factors. Regional procedures can also be used safely in high-risk patients, but often
obscure the initial diagnosis.
Keywords lithotomy position - positioning associated compartment syndrome - well-leg-compartment
syndrome
