Compartment syndrome in the well leg resulting from fracture-table positioning.

A variety of patient positioning options exist on modern fracture tables for use during intramedullary nailing procedures. With the advent of interlocking and reconstruction nailing, some of these procedures can be complicated and prolonged. The use of the hemilithotomy position for prolonged intramedullary nailing procedures can result in the development of a compartment syndrome in the uninjured leg, no matter what type of suspension device is used for that leg. The occurrence of this iatrogenic injury in the patient's well leg can be devastating in light of the contralateral fracture. Two patients at this institution have had such a condition in the past two years, and the authors have revised their positioning procedures. Review of the surgical literature shows that this complication has been seen in urologic, gynecologic, and general surgical patients, but has not been widely reported in the orthopaedic population. Recommendations for avoiding this problem include the use of other positions or distraction devices when performing intramedullary nailings, or, when the hemilithotomy position cannot be avoided, early intraoperative repositioning of the leg when possible.