4/5/2023 0 Comments Compartments of leg and thigh![]() Fractures are the most common cause of anterior compartment syndrome, accounting for over 65% of the cases. The most common causes of anterior compartment syndrome are trauma (fractures, crush injuries, contusions, gunshot wounds), tight casts or dressings, extravasation of IV infusion, burns, post-ischemic swelling, bleeding disorders, and arterial injury. When the pressure inside the anterior compartment increases, tissue perfusion can be compromised, which may lead to irreversible muscle and nerve damage – muscle necrosis. The anterior compartment of the lower leg is the most common site for acute compartment syndrome. Errors in Hox gene expression can lead to malformations in the limbs. These genes control patterning and consequently morphology of the developing limb in the human embryo. SHH activates specific HOX genes – Hoxd-9, Hoxd-10, Hoxd-11, Hoxd-12, Hoxd-13 – which are essential in limb polarization and regional specification. ![]() The zone of polarizing activity (ZPA) produces SHH, promoting the organization of the limb bud along the anterior-posterior axis. ![]() The specific fibroblast growth factor involved in hindlimb development is Fgf10, which is stimulated by Tbx4. ![]() The apical ectodermal ridge (AER) produces a fibroblast growth factor (Fgf), which promotes the outgrowth of the limb buds by stimulating mitosis. Retinoic acid is a global organizing gradient that initiates the production of transcription factors that specify regional differentiation and limb polarization. Several factors influence the formation of the limb bud vasculature and musculature including retinoic acid, sonic hedgehog (SHH), HOX genes, apical ectodermal ridge (AER) and the zone of polarizing activity (ZPA). The artery was reconstructed with interposition of the smaller saphenous vein, which was already interrupted through the initial trauma.The limb buds of the embryo begin to form about 5 weeks after fertilization as the lateral plate mesoderm migrates into the limb bud region and condenses along the central axis to eventually form the vasculature and skeletal components of the lower limb. A complete fasciotomy of all the lower limb muscle compartments was immediately performed. The limb had a disastrous compartment syndrome of the thigh and lower leg with disruption of the popliteal neurovascular bundle however, no bones in the limb were fractured. CT scan showed a huge haematoma in the thigh with active bleeding out of the popliteal artery into the haematoma which has already expanded into the muscle compartments of the lower leg. He presented with a sensomotor deficit in his left lower leg with full paralysis of the shank muscles and absence of all foot pulses. We present a previously unreported case in which the limb of a 36-year-old man was run over by a 25-ton truck. The muscle compartments in the thigh have a more compliant fascia and blend anatomically into the open compartments of the pelvis, thus compensating higher volumes than the compartments in the lower leg. Increasing intracompartmental pressure which suppresses microcirculation and capillary perfusion may lead to cellular anoxia and muscle ischemia. ![]() Compartment syndrome of the thigh is a rare condition, potentially resulting in devastating functional outcome. ![]()
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