Paediatric well leg compartment syndrome following femoral fracture fixation: A case report

Well leg compartment syndrome is a rare complication of orthopaedic surgery, especially in paediatric patients. The aim of this study is to present a single case of this disease and to provide recommendations for its management. A 16-year-old male semi-professional footballer sustained a midshaft femoral fracture on the field and subsequently underwent fracture fixation with an intramedullary nail. Following surgery, the patient complained of severe pain in the opposite (well) leg and displayed neurological deficits on examination. He was clinically diagnosed with acute compartment syndrome and underwent emergent two-compartment fasciotomy. The postoperative course was complicated by a persistent foot drop, wound infection, residual compartment swelling preventing direct wound closure, and status epilepticus necessitating intensive care admission. At three-month follow up the patient had a residual foot drop. Well leg compartment syndrome is a rare complication of orthopaedic surgery; however, it can have devastating consequences, particularly in the paediatric population. We recommend intraoperative mobilization of the well leg every two hours for long operations, normotensive blood pressure control to ensure adequate tissue perfusion, and minimal elevation of the well leg. Frequent postoperative examinations may facilitate early diagnosis and management.