Kalsi Rajeev, Dempsey Amy, Bunney Edward Bradshaw
Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
J Emerg Med. 2012 Aug;43(2):e101-6. doi: 10.1016/j.jemermed.2009.08.059. Epub 2009 Dec 14.
Compartment syndrome of the foot as a result of a calcaneal fracture has received only occasional consideration in the recent Emergency Medicine literature, yet it remains a challenging diagnosis to make. The devastating consequences of untreated compartment syndrome of the foot include clawing of the lesser toes, stiffness, chronic pain, motor weakness, neurovascular dysfunction, and fixed deformities of the foot. In addition to decreased quality of life, this also leads to lost time at work and lost wages. Calcaneal fractures can lead to devastating long-term disability that is often permanent and life-altering for patients suffering from this injury. Approximately 10% of patients with these fractures develop compartment syndrome of the foot. The pathogenesis of calcaneal fractures is well recognized, and the surgical treatment techniques continue to evolve.
The objectives of this case report are to increase understanding of the pathophysiology of compartment syndrome and its short- and long-term consequences, to improve the ability to diagnose compartment syndrome, and to emphasize the need for emergent surgical treatment.
A 37-year-old man sustained an isolated comminuted, extra-articular calcaneus fracture that resulted in compartment syndrome of the foot. The diagnosis required measurement of several compartments in the foot. He subsequently received emergent operative decompression and experienced a positive outcome.
Diagnosis of compartment syndrome of the foot is a clinical one, and diagnostic tools such as radiographic imaging and compartment pressure monitoring can help confirm the diagnosis. It is also important to understand the long-term sequelae of this injury and to involve a specialist early in the decision-making and treatment process.
跟骨骨折导致的足部骨筋膜室综合征在近期的急诊医学文献中仅偶尔被提及，但仍是一个难以诊断的病症。未治疗的足部骨筋膜室综合征会带来严重后果，包括小趾爪形畸形、僵硬、慢性疼痛、运动无力、神经血管功能障碍以及足部固定畸形。这不仅会降低生活质量，还会导致误工和工资损失。跟骨骨折会导致严重的长期残疾，对于遭受此类损伤的患者来说，这种残疾往往是永久性的且会改变生活。约10%的此类骨折患者会发生足部骨筋膜室综合征。跟骨骨折的发病机制已得到充分认识，手术治疗技术也在不断发展。
本病例报告的目的是增进对骨筋膜室综合征病理生理学及其短期和长期后果的理解，提高诊断骨筋膜室综合征的能力，并强调急诊手术治疗的必要性。
一名37岁男性发生孤立性粉碎性、关节外跟骨骨折，导致足部骨筋膜室综合征。诊断需要测量足部的多个骨筋膜室。他随后接受了急诊手术减压，结果良好。
足部骨筋膜室综合征的诊断是临床诊断，影像学检查和骨筋膜室压力监测等诊断工具有助于确诊。了解这种损伤的长期后遗症，并在决策和治疗过程早期让专科医生参与也很重要。
