Title: Gluteal Compartment Syndromes due to Prolonged Immobilization after Drug Intoxication: A Case Series

Author(s): Daniel Sabo, DO; Nathan Forren, DO; Nicholas Accurso, DO

Email:  Dsabo@mercy.com

Introduction: The diagnosis of gluteal compartment syndrome can be an illusive diagnosis and often goes undiagnosed. Unfortunately for patients if the diagnosis is delayed, they may have already developed non-repairable musculature death and sciatic nerve damage. This leads to a sequalae of other negative findings from renal failure to cardiac arrhythmias both of which may lead to death. The following cases we present to you provide important characteristics of gluteal compartment syndrome and acute management.

Case Report(s): Three cases will be presented regarding patients with past medical history including polysubstance abuse subsequently found to have gluteal compartment syndrome requiring operative intervention.

Discussion: Gluteal compartment syndrome is a rare but serious condition that can result from prolonged immobilization. This case series described multiple patients who developed gluteal compartment syndrome following prolonged immobilization around drug intoxication. The classical and first line treatment of compartment syndrome is urgent fasciotomy. Adequate and extensive compartment release is necessary and the posterior approach to the hip is the most frequently used for gluteal compartment syndrome. Delayed Fasciotomies carry the risk of encountering necrosed muscle as noted in these patients. Immediate fasciotomy is required to prevent detrimental outcomes. Renal failure, multiple organ failure, cardiac arrhythmias, and death are all sequala of untreated compartment syndrome. Threshold to perform fasciotomy should be low and is often based on clinical presentation, therefore it is important to know the signs and symptoms of compartment syndrome, as outline by the above cases.