The stiff leg sign in acute thigh & gluteal compartment syndrome: A case report

Introduction Gluteal and thigh compartment syndromes are rare orthopedic emergencies, which have seldom been reported in the literature. If left untreated, the complications can be significant: ranging from long-term motor deficits to amputation and even death. Urgent recognition is therefore paramount. Case Report A 40-year-old man presented to the Emergency Department after a prolonged entrapment under mounds of dirt at a construction site. He was diagnosed with acute thigh and gluteal compartment syndrome despite initial compartment pressures not reaching a diagnostic threshold, and successfully treated with operative fasciotomy. His presentation at time of diagnosis was characterized by a novel physical exam finding: “Stiff Leg Sign,” where the patient's leg was found to be maintained in extension and abduction, secondary to increased gluteal and thigh compartment pressures, which persisted while under anesthesia sedation until the compartments were released. Discussion Acute thigh and gluteal compartment syndromes are uncommon and require a high degree of clinical suspicion alongside the use of diagnostic tests such as compartment pressure monitoring. The timely recognition and comprehensive treatment of these compartment syndromes led to a positive outcome for the patient with full return of neurologic and strength function at 3-month follow-up, which led to full return to work and activities with more than 2.5 years follow-up. Conclusions We propose the “stiff leg sign” as a novel physical exam finding that can facilitate the identification of simultaneous thigh and gluteal compartment syndrome.