{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T22:58:40Z","timestamp":1774911520676,"version":"3.50.1"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>For the osteosynthetic treatment of fractures of the femur and optimal exposure of the fractured region including radiological fluoroscopy, it is often recommended to carry out positioning on an extension table, with positioning of the contralateral lower limb on a leg holder. It is not uncommon for this to result in peri- and postoperative damage of varying severity as a result of patient positioning. Some cases of damage due to improper positioning can be found in the literature in the context of urological, general and gynaecological surgery. This is often associated with the responsible surgical speciality, which often requires a lithotomy position and thus the bilateral positioning of the healthy lower extremities. The aim of this article is to draw attention to the well leg compartment syndrome (WLCS) of the unaffected side in orthopaedic surgery, by presenting a case of our own and to point out particular risks on the basis of a current literature review, as well as\n        to discuss procedural suggestions for prevention.<\/jats:p>\n                  <jats:p>A literature search was carried out using the online medical database \u201cPubMed\u201d (search date 20.02.2025). After entering the search terms \u201cWell leg compartment syndrome AND orthopaedic surgery\u201d, \u201cWell leg compartment syndrome AND orthopaedics\u201d and \u201cWell leg compartment syndrome AND hemilithotomy positioning\u201d, a total of 175 search hits were found. After removal of duplicates and an extended full-text search, a total of 14 case reports were selected and included in the current publication.<\/jats:p>\n                  <jats:p>This report describes a compartment syndrome of the lower leg of the positioned uninjured limb (well leg compartment syndrome, WLCS) in a 63-year-old patient following prolonged emergency intramedullary nail osteosynthesis of a complex femur fracture, with an operating time of 8:12\u00a0h.<\/jats:p>\n                  <jats:p>In the literature, WLCS of the lower leg in orthopaedic surgery is found in most cases after intramedullary nail osteosynthesis of the femur in patients positioned in modified lithotomy. The operating time was over 2\u00a0h in most cases. The diagnosis of compartment syndrome was made in a wide time window between immediately postoperatively and up to 3 days after the operation. The treatment of choice in the majority of cases was fasciectomy of all 4 compartments of the lower leg. No statement can be made about other risk factors in the cases presented in the research \u2013 due to missing or limited data.<\/jats:p>\n                  <jats:p>Position-associated acute compartment syndrome in orthopaedic surgery is a rarely described complication. Risk factors include a long operating time, increased BMI, increased blood loss, low intraoperative blood pressure and peripheral vascular disease. The uninjured leg should be correctly positioned in the lithotomy position intraoperatively (90\u00b0 flexion in hip and knee) and be as little as possible in the case of known risk factors. Regional procedures can also be used safely in high-risk patients, but often obscure the initial diagnosis.<\/jats:p>","DOI":"10.1055\/a-2735-3521","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:15:09Z","timestamp":1764202509000},"page":"136-142","source":"Crossref","is-referenced-by-count":0,"title":["The Well Leg Compartment Syndrome in Orthopaedic Surgery \u2013 A Case Report with Review"],"prefix":"10.1055","volume":"164","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8534-3982","authenticated-orcid":false,"given":"Andreas Benedikt","family":"Bauer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Unfallchirurgie und Orthop\u00e4die, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Dallacker-Losensky","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Unfallchirurgie und Orthop\u00e4die, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Joachim","family":"Riesner","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Unfallchirurgie und Orthop\u00e4die, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"668","DOI":"10.5435\/00124635-201011000-00004","article-title":"Traction table-related complications in orthopaedic surgery","volume":"18","author":"MA Flierl","year":"2010","journal-title":"J Am Acad Orthop Surg"},{"key":"ref2","first-page":"698","article-title":"Compartment syndrome as a complication of the lithotomy position","volume":"59","author":"I 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