Atraumatic Isolated Peroneal Compartment Syndrome: A Case Report

Acute compartment syndrome (ACS) is a surgical emergency that is frequently brought on by trauma and is characterized by increased pressure inside a closed osteofascial compartment. However, because of its unusual presentation and absence of acute trauma, atraumatic ACS, especially when isolated to the peroneal compartment, is uncommon and challenging to identify. We describe a 24-year-old man who had no prior history of direct trauma and who presented with atraumatic left leg discomfort and swelling after physical activity. At another hospital, muscle cramps were initially diagnosed, but as symptoms worsened, additional testing was necessary. A physical examination showed a hard lateral compartment, loss of dorsiflexion, increased creatine kinase (CK) and myoglobin levels, and decreased feeling over the dorsum and lateral portions of the foot. No bone pathology was visible in the radiography imaging. Surgical decompression via fasciotomy revealed necrotic peroneal muscles and a hematoma collection. The patient underwent staged debridement and wound management, eventually achieving wound closure and functional recovery with physiotherapy. Six-month follow-up showed restored muscle power. This case emphasizes the importance of considering ACS in atraumatic leg pain and swelling, particularly when CK levels are elevated. • Acute compartment syndrome (ACS) is a limb-threatening surgical emergency. • Atraumatic isolated peroneal compartment syndrome is uncommon and challenging to identify. • If compartment syndrome is in doubt, an elevated level of creatinine kinase besides the A clinical examination can help diagnosis. • Surgical decompression of the compartment syndrome should be done as early as possible to prevent complications.