Alrayes Majd M, Alqudah Mohammad, Bani Hamad Walaa, Sukeik Mohamed
Department of Trauma and Orthopedics, Dammam Medical Complex, Dammam 32210, Saudi Arabia.
Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital, Khobar 34423, Saudi Arabia.
World J Orthop. 2023 Jul 18;14(7):582-588. doi: 10.5312/wjo.v14.i7.582.
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.
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.
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.
急性小腿骨筋膜室综合征是一种众所周知的骨科急症,如果不立即治疗可能会导致严重后果。多个骨筋膜室通常会受累,有明确的外伤史以及典型的症状和体征。然而,孤立性小腿外侧骨筋膜室综合征相对少见,常因无外伤的非典型表现及缺乏特异性体征而被误诊。
一名31岁男性患者在参加一场足球比赛一天后,因左小腿剧痛且无法活动而前来我院急诊室,尽管此前并无明确的外伤史。该患者在来我院之前曾前往另一家医院,在那里他被诊断为软组织损伤,并仅接受了简单的止痛治疗后出院回家。临床检查发现,患者左腿外侧骨筋膜室紧张,有明显压痛。背屈和足内翻会加重疼痛。该肢体的神经血管检查正常。我们怀疑是骨筋膜室综合征,但由于表现不典型,且我院可随时进行磁共振成像(MRI)检查,我们立即进行了MRI检查,结果证实外侧骨筋膜室内有一个大血肿,可能伴有部分腓骨长肌近端撕裂。患者立即接受了急诊切开筋膜减压术。患者目前术后18个月,已完全康复,可无限制地完全参与体育运动。
由于缺乏特异性体征导致的非典型表现使得孤立性小腿外侧骨筋膜室综合征难以诊断。被动内翻和背屈时疼痛以及主动外翻无力可能是较为敏感的体征。