# Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report

## TL;DR

A 76-year-old man developed compartment syndrome in multiple regions after being crushed by a tree, requiring emergency surgery and a modified surgical approach for effective treatment.

## Contribution

A modified surgical approach extending the Kocher–Langenbeck incision is proposed for treating ipsilateral gluteal and thigh compartment syndrome.

## Key findings

- Emergency fasciotomy was performed for compartment syndrome in the right forearm and left lower leg.
- A single incision using the extended Kocher–Langenbeck approach successfully decompressed gluteal and thigh compartments.
- The case demonstrates the effectiveness of this approach for treating multiple compartment syndromes.

## Abstract

Compartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions or in the ipsilateral gluteal region and thigh.

We report on a 76-year-old man who was obliquely crushed under a tree extending from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with compartment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was performed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intracompartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes. A fasciotomy was performed, the gluteal skin incision was made according to the Kocher–Langenbeck approach (one of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This surgical approach enabled the decompression of the compartments through a single incision and allowed for easier wound treatment and closure.

This case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions. Extension of the Kocher–Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral gluteal and thigh compartment syndrome.

The online version contains supplementary material available at 10.1186/s12245-024-00675-5.