Alrayes MM, Alqudah M, Bani Hamad W, Sukeik M. Isolated lateral leg compartment syndrome: A case report. World J Orthop 2023; 14(7): 582-588 [PMID: 37485425 DOI: 10.5312/wjo.v14.i7.582]
Corresponding Author of This Article
Mohamed Sukeik, FRCS (Ed), MD, Surgeon, Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital, King Salman Bin Abdulaziz Road, Khobar 34423, Saudi Arabia. msukeik@hotmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2023; 14(7): 582-588 Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.582
Isolated lateral leg compartment syndrome: A case report
Majd M Alrayes, Mohammad Alqudah, Walaa Bani Hamad, Mohamed Sukeik
Majd M Alrayes, Department of Trauma and Orthopedics, Dammam Medical Complex, Dammam 32210, Saudi Arabia
Mohammad Alqudah, Mohamed Sukeik, Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital, Khobar 34423, Saudi Arabia
Walaa Bani Hamad, Department of Radiology, Dr. Sulaiman Al-Habib Hospital, Khobar 34423, Saudi Arabia
Author contributions: Alrayes MM and Alqudah M contributed to manuscript writing, and literature search; Bani Hamad W contributed by providing and reviewing the radiological content; Sukeik M was the primary surgeon of the case and contributed to scientific content, paper revision, editing, and overall supervision.
Informed consent statement: Informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed Sukeik, FRCS (Ed), MD, Surgeon, Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital, King Salman Bin Abdulaziz Road, Khobar 34423, Saudi Arabia. msukeik@hotmail.com
Received: February 10, 2023 Peer-review started: February 10, 2023 First decision: April 13, 2023 Revised: April 25, 2023 Accepted: April 27, 2023 Article in press: April 27, 2023 Published online: July 18, 2023 Processing time: 158 Days and 2.3 Hours
Abstract
BACKGROUND
Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately. Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs. However, isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.
CASE SUMMARY
A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma. The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics. On clinical examination, the left leg showed a tense lateral compartment with severe tenderness. The pain was aggravated by dorsiflexion and ankle inversion. Neurovascular examination of the limb was normal. We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging (MRI) was readily available in our institution, we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear. The patient was taken immediately for an emergency open fasciotomy. The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.
CONCLUSION
Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult. Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.
Core Tip: Atraumatic isolated lateral leg compartment syndrome is rare and constitutes a diagnostic challenge due to the atypical presentation and lack of pathognomonic signs. It should be considered even in the context of atraumatic events. Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs. Drop foot is a delayed presentation as a result of deep peroneal nerve involvement. A high index of clinical suspicion is the key to early diagnosis and timely surgical intervention.
