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Acute compartment syndrome of the thigh in a body builder following open reduction and internal fixation for proximal femur fracture
  1. Matthew Pritchard1,
  2. Paul Baggott2,
  3. Liam Donnelly3 and
  4. Joshua Jacob2
  1. 1 Emergency Department, Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
  2. 2 Trauma and Orthopaedics, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
  3. 3 Emergency Department, Ealing Hospital NHS Trust, Southall, London, UK
  1. Correspondence to Dr Matthew Pritchard; matthew.pritchard{at}


Acute compartment syndrome (ACS) of the thigh following femoral fracture has been rarely reported in previous literature. This condition must be diagnosed quickly to prevent the affected limb becoming ischaemic. We document the management of ACS of the thigh in a healthy male patient who suffered a proximal femur fracture following a high-speed road traffic accident. Early identification of characteristic clinical signs allowed for a diagnosis of ACS to be made and then managed with an emergency fasciotomy. The patient is a bodybuilder with an exceptionally large muscle mass. This made ACS more difficult to identify and wound closure a complex process over a period of 13 days. We aimed to highlight the importance of maintaining a high index of suspicion for ACS following traumatic injuries, recognising that ACS in larger patients can be mistaken for an increased analgesia requirement and closing fasciotomies slowly using mass tension sutures.

  • Orthopaedic and trauma surgery
  • Pain

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  • Contributors MP was the lead author for this case report, involved in the management of the patient and led the writing of the report. JJ was the consultant in charge of this case, was actively involved in decision making and patient treatment, and contributed to the report. JB was the registrar on-call when the patient presented to the hospital; he was actively involved in patient treatment and contributed to the report. LD is an emergency department senior house officer who was not involved in patient management but contributed significantly in the write-up of the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.