[Missed acute compartment syndrome of the lower leg]

After some considerable delay, acute compartment syndrome of the lower leg was diagnosed in a 17-year-old man, a 32-year-old man and a 76-year-old woman. The first patient was an accident victim whose leg was continuously bandaged for three days following treatment of a complicated femur fracture and lower leg wounds, so that inspection was not possible. In the second patient who was also an accident victim, the haemodynamics and the neurological condition initially required so much attention that the compartment syndrome was only noticed after 48 hours. The woman presented with a cold, painful left foot. She had atrial fibrillations. A thrombus mass was removed endovascularly from the femoral artery. She controlled her own pain medication by means of an epidural catheter, but as a result of that a reperfusion compartment syndrome was only noticed at a later stage. These cases reveal that it can be very difficult to establish the diagnosis of acute compartment syndrome, especially if this is masked by the already quite subjective symptoms of the clinical picture. The consequences of a missed compartment syndrome are serious, with a considerable impairment of the limb concerned that often necessitates amputation. Awareness and healthy suspicion are the keys to a quick and timely diagnosis. Prophylactic fasciotomies must be carried out on the basis of several clear indications.