Compartment syndrome following an acute correction of a neglected case of Blount's disease: What lessons can be learned?

The management of neglected forms of Blount's disease is a challenge in developing countries. Both progressive and acute correction can be performed with a significant risk of compartment syndrome. Very few cases of this complication have been reported in the literature. We report a rare case of compartment syndrome after acute correction for neglected Blount's syndrome in a teenager and the lessons learned in the management of this complex case. A 16-year-old girl was admitted to our unit with a severe bilateral genu varum since childhood. The deformities were classified as Langeskiold Stage VI. Considering the complexity of the case, we treated the limbs in different operating times. We started with the left side. Under general anesthesia with a caudal block, a tibial valgization osteotomy with elevation of the tibial plateau, a fibular subtraction osteotomy and a fasciotomy were performed. Postoperative course was negative with a compartment syndrome and dry gangrene. An amputation was performed with no specific follow-up. On the right side, the same procedure was performed 45 days after the first one, this time with an initial minimal correction of the varus with a bivalved cruro pedal cast for better monitoring, and local care and we used to carry out a secondary valgization by external manipulations before obtaining the bone callus. The postoperative course was simple. Compartment syndrome remains a potential complication of surgical treatment of neglected forms of Blount's disease. Clinical diagnosis is difficult with signs that may be masked by locoregional anesthesia. Progressive correction, preventive fasciotomy, opening and monitoring of the cast may prevent its occurrence.