Working Diagnosis:
Quadriceps Compartment Syndrome, acute, traumatic
Anemia, acute, secondary to bleed from quadriceps contusion

Treatment:
Fasciotomy; successful compartment decompression, wound vacuum, elevation and immobilization for several days, overall uncomplicated hospital course. Follow up CBC with observation of improving trend. Case Photo #1 , Case Photo #2
Case Photo #3

Outcome:
Gradual rehabilitation, by four weeks post-op, patient with full knee flexion, able to perform single leg knee bends, beginning to start jogging and stationary bicycle. Jogging and running without complication, never returned to football that season. Plans to play football following year. Comfortable in the gym, running, jumping, will start summer training as scheduled. Case Photo #5

Author's Comments:
Traumatic quadriceps compartment syndrome has been demonstrated by cases in literature, however, it is rare, as compared with anterior tibial compartment syndrome. One reason for this is likely due to the larger size of the anterior compartment of the thigh as compared to the pre-tibial region. It is important to consider this diagnosis whenever there is a case of pain out of proportion with the exam, vascular or neurologic deficits, or in the setting of weakness without obvious cause.

References:
1. Riede U, Schmid MR, Romero J. Arch Orthop Trauma Surg. 2007 May;127(4):269-75. Epub 2006 Jul 29. Conservative treatment of an acute compartment syndrome of the thigh.

2. Kuri JA 2nd, Difelice GS. J Bone Joint Surg Am. 2006 Feb;88(2):418-20. Acute compartment syndrome of the thigh following rupture of the quadriceps tendon. A case report.

3. Burns BJ, Sproule J, Smyth H. Br J Sports Med. 2004 Apr;38(2):218-20. Acute compartment syndrome of the anterior thigh following quadriceps strain in a footballer.

4. Lindsay MB. Acad Emerg Med. 1999 Aug;6(8):860-1. Quadriceps compartment syndrome from minor trauma.

5. Robinson D, On E, Halperin N. J Trauma. 1992 Feb;32(2):183-6. Anterior compartment syndrome of the thigh in athletes--indications for conservative treatment.

6. Rööser B, Bengtson S, Hägglund G. J Orthop Trauma. 1991;5(1):57-9. Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases.

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