Compartment syndrome of the leg after treatment of a femoral fracture with an early sitting spica cast. A report of two cases

Compartment syndrome results from elevated tissue pressure within an osseofascial compartment that is caused either by an increase in the contents of the compartment, such as that produced by an accumulation of blood or other fluids, or by a decrease in the volume of the compartment, such as that occurring after the application of a constrictive cast or dressing1,2. The pathophysiology of compartment syndrome is well defined: as compartment pressure rises above arteriolar pressure, capillary flow decreases while venous outflow is obstructed, thus impairing perfusion to compartment structures1. Permanent losses of neural and muscular function are the feared outcomes. Compartment syndromes occur most frequently after lower-extremity trauma, often after a high-energy injury. We report the cases of two children in whom compartment syndrome of the leg developed after a low-energy fracture of the femoral shaft was treated with an early sitting spica cast. The parents of both children were informed that data concerning their cases would be submitted for publication. Case 1. A twenty-month-old boy fell and sustained a spiral midshaft femoral fracture. The fracture was not angulated, the limb was shortened by 1 cm, and the patient had normal circulation and neurologic function distal to the fracture. There were no signs of injury to the leg. A long-leg splint was applied in the emergency department and, four hours after the injury, a spica cast was applied in the operating room with the patient under general anesthesia. The casting technique, which was described by Czertak and Hennrikus3 in 1999 and is a modification of the technique described by Kasser4, involved three steps: (1) placement of a below-the-knee fiberglass cast on the affected leg (including the foot) with felt padding along the calf and the popliteal fossa, (2) application of a …