Acute Compartment Syndrome Following a Low-Energy Ankle Injury: Case Report and Review of the Literature

A healthy 21-year-old male active-duty sailor experienced acute compartment syndrome (ACS) of the right lower extremity after sustaining an inversion ankle injury during a summer football practice. In the emergency room, he was diaphoretic, with diffuse tenderness over the lateral leg and ankle and mild paresthesia over the dorsum of the foot. He had palpable pedal pulses and no pain with passive great toe extension. Initial radiographs demonstrated no acute osseous abnormality. However, the emergency department team ordered a creatine kinase (CK) out of concern for rhabdomyolysis. It returned elevated at 5,100 U/L. The patient was admitted for intravenous fluids, analgesics, and CK monitoring. In the morning, the patient reported minimal pain in his leg and ankle and improved numbness in his foot. His CK had decreased slightly to 5,018 U/L. He was discharged with a clinic follow-up appointment for the following morning. In the clinic, he reported worsening pain and numbness and an inability to dorsiflex his foot. He was immediately sent to the emergency room for management. On arrival, he exhibited tenderness to palpation of his anterior compartment musculature, as well as paresthesias and pain with passive extension of the big toe. After pressure measurements were obtained with an intracompartmental pressure monitoring needle, he was diagnosed with compartment syndrome and underwent dual-incision, 4-compartment fasciotomy, which led to symptom resolution. ACS should be ruled out when clinical suspicion exists, even if the mechanism of injury does not support it. This patient's development of ACS after a non-contact injury represents a rare yet significant cause of ACS that should be considered in future patients with similar injuries.