Delayed Presentation of Compartment Syndrome of the Proximal Lower Extremity After Low-Energy Trauma in Patients Taking Warfarin

Abstract not available. Introduction provided instead.

Compartment syndrome is a well-known phenomenon that occurs after injuries to the lower extremities. Clinicians are easily alerted to its presence in the leg after tibial fracture when the patient presents with firm muscular compartments and significant pain that increases with passive stretching of the ankle or the digits of the foot. However, making the diagnosis without a clear history of significant trauma and an easily reproducible physical examination is difficult. Confounding variables (eg, patient comorbidities, medication profiles) become especially important in the elderly population. These patients usually have multiple medical problems being treated with medications. Anticoagulants, warfarin in particular, dramatically impair elderly patients’ ability to recover from minor trauma. As demonstrated in this report, continued intramuscular bleeding can progress to compartment syndrome in patients with very limited physiologic reserve. We describe the cases of 3 patients who developed compartment syndrome after sustaining very low-energy trauma while anticoagulated with warfarin for chronic cardiac conditions.