Page 23 - Journal of Special Operations Medicine - Fall 2016

Lower Extremity Compartment Syndrome
From Prolonged Limb Compression and Immobilization
During an Airborne Operation

Brian C. Smedick, PA-C; David W. Van Wyck, DO

ABSTRACT
Acute compartment syndrome (ACS) involving the leg most jumps, there are paratroopers tagged as “no-
can occur in association with various traumatic and drops,” a term referring to the failure of a paratrooper
nontraumatic conditions, and it can have serious long- to exit the aircraft after take-off. No-drops may be due
term consequences when unrecognized or untreated. to jump refusal, in which case punitive action may be
Nontraumatic causes of ACS, such as those associated taken against the Soldier, or may be related to safety or
with cases of prolonged immobilization and/or extrem- medical issues. Common complaints by those unable to
ity compression, can be easily overlooked, and several complete the jump include excessive fatigue or weakness
cases of ACS occurring with prolonged surgical posi- that is commonly attributed to dehydration. Our case
tioning can be found in the literature. We present the demonstrates the potential for more serious underlying
case of a 19-year-old Army paratrooper who developed pathology. To our knowledge, this is the first reported
acute anterior and lateral compartment syndrome of the case of ACS in a paratrooper related to prejump con-
lower extremity after being immobilized in an aircraft ditions, although less serious and unreported cases of
for hours with several hundred pounds of equipment rhabdomyolysis and ACS are possible. The purpose of
compressing his lower extremities. To our knowledge, this case report is to provide awareness to unit leaders,
this is the first documented case of ACS occurring as a jumpmasters, and evaluating providers of an emergent
result of prejump conditions. It demonstrates a poten- condition that must be rapidly identified and treated to
tially serious complication that could result in medical avoid long-term disability or, in extreme cases, death.
separation and/or permanent disability of the service
member. ACS of the extremity should be considered in Case Presentation
any Soldier who is required to bear heavy loads, is im-
mobilized for several hours at a time, and complains A 19-year-old, male, active-duty paratrooper was ad-
of symptoms such as extremity pain, numbness, and mitted to a civilian facility with left leg numbness, weak-
weakness. ness, and swelling after he was unable to complete an
airborne training jump into a Joint Readiness Training
Keywords: acute compartment syndrome, pressure; Center predeployment exercise. The patient boarded a
immobilization plane at Ft. Bragg, North Carolina, in his usual state
of health and made a nearly 3-hour flight to Ft. Polk,
Louisiana, where he was to make a parachute jump into
the training grounds.
Introduction
Acute compartment syndrome (ACS) involving the leg is Prior to departure, the paratrooper secured himself in
a potentially severe complication that arises from a num- his jump harness (a series of straps designed to help
ber of traumatic and nontraumatic conditions. These in- carry the paratrooper’s equipment and parachute) and
clude situations involving direct local pressure on the attached his equipment to the harness. The patient es-
lower extremity, as may occur in states of prolonged im- timated that he was carrying approximately 100 lb of
mobilization, or when blood flow is interrupted due to equipment, including his rucksack, weapon, and ammu-
arterial occlusion or entrapment. We present a case of nition. The harness included two straps that wrapped
1–3
ACS involving the anterior compartment of the left leg tightly around the inner thighs and buttocks. He was
of a paratrooper who was immobilized for several hours waiting in a seated position in the harness for 2 hours
prior to a planned airborne jump. with the weight of his equipment supported on his lap
but noted no problems ambulating to the aircraft for
Airborne operations are physically demanding, and para- boarding. He reported good sleep, good oral hydration,
troopers often jump with heavy loads of equipment. With and food intake prior to and after boarding the aircraft.

5