Acute non-traumatic compartment syndrome of anterior compartment of leg; an unusual presentation: A case report

Abstract

2. Case report50-year-old male, a cottage industry owner, presented at 02:00complainingoffeelingcold,shiveringandwithseverepaininrightleg. He had no prior history of leg pain. The previous morning hehad played football for the first time for 15 min when the outsidetemperaturewasabouttwodegreecelsius.Hehad nofall,twistingof leg/foot, or direct trauma to the leg. Throughout the day he hadperformed his routine activities without any discomfort or pain.Approximately 12 h laterhestartedfeeling cold. Hewas putunder5layersofblanketswhichdidnothelpandtheshiveringpersisted.Within anhourhedeveloped paininright legand lowerabdomen.He vomited twice and passed loose stools once.Oral NSAID’S prescribed by a GP did not relieve his pain.AnotherGPgaveananalgesicinjectionalongwithatranquiliser.Asthe pain persisted he presented to the emergency services.He was afebrile. Local examination revealed a swollen, wood-hard, tender, anterior compartment of the leg with dilatedsuperficial veins (Figs. 1 and 2). Passive dorsiflexion of the toesand ankle were painful. Extensor hallucis longus and extensordigitorum longus had grade 1/5 motor power and tibialis anteriorgrade 2/5. The dorsum of the foot had hypoesthesia. Dorsalis pedisand posterior tibial pulses were well palpable.Baseline haematocrit and biochemistry values were withinnormal limits. The radiographs were normal.The patient was immediately taken to theatre for decompres-sion. Fasciotomy by Mubarak’s single longitudinal lateral incisionwas done within 6 h of onset of leg pain.