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Bango J, Zhang E, Aaron DL, Diwan A. Two cases of acute anterolateral compartment syndrome following inversion ankle injuries. Trauma Case Rep 2020; 30:100371. [PMID: 33204802 PMCID: PMC7649348 DOI: 10.1016/j.tcr.2020.100371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Compartment syndrome is a limb threatening, and sometimes life-threatening medical condition. It usually occurs in high energy lower extremity injuries, commonly in the younger patient with classic signs and symptoms. Pain out of proportion to exam is one of the key elements in diagnosis. A high vigilance for signs and symptoms of this condition should be present on most physicians' radars who treat emergency conditions, as this case report demonstrates, the mechanism and story are not always classic. Presentation of cases Two cases of young, healthy adults who underwent fasciotomy for compartment release for compartment syndrome isolated to the anterolateral compartment, but who did not sustain a high energy trauma, but rather a twisting ankle injury. Conclusion Compartment syndrome can occur in young, healthy, active patients with a lower energy twisting injury and without fracture. A high level of suspicion on the clinicians' part will prevent adverse outcomes to the patient.
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Affiliation(s)
- Jugert Bango
- Department of Orthopedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655, United States of America
| | - Evan Zhang
- Department of Orthopedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655, United States of America
| | - Daniel L Aaron
- Department of Orthopedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655, United States of America
| | - Amna Diwan
- Department of Orthopedic Surgery, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655, United States of America
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Traumatic posterior tibial artery occlusion in a soccer player: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:153-156. [PMID: 32082726 DOI: 10.5606/tgkdc.dergisi.2018.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/05/2017] [Indexed: 11/21/2022]
Abstract
A 24-year-old male professional soccer player sustained a right ankle contusion due to blunt kick toward the medial malleolus level during a soccer game. He stopped playing due to pain, coldness, and paresthesia on his right foot. Computed tomography angiography revealed a 4.5 cm occlusion on the posterior tibial artery at the right ankle level of which the distal segment was filled with collateral arteries. After the diagnosis of the traumatic occlusion, the patient underwent angiography for recanalization with thrombolysis in an external center, which was unsuccessful. Crural artery injuries after blunt sport traumas are very rare. In knee and ankle traumas with ischemic symptoms, vascular injuries should be excluded with prompt examination.
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Chen YP, Ho WP, Wong PK. Acute compartment syndrome secondary to disruption of the perforating branch of the peroneal artery following an acute inversion injury to the ankle. Int J Surg Case Rep 2014; 5:1275-7. [PMID: 25460492 PMCID: PMC4275801 DOI: 10.1016/j.ijscr.2014.11.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/08/2022] Open
Abstract
Vascular disruption and compartment syndrome, although rare, can be severe sequelae of an inversion ankle injury. The perforating branch of the peroneal artery passes anteriorly through a hiatus in the interosseous membrane, and is susceptible to stresses in inversion injury of the ankle. Acute compartment syndrome related to vascular lesions may rapidly present in hours after ankle sprain.
INTRODUCTION Although ankle sprain by inversion is common in daily practice, acute compartment syndrome following ankle inversion injury is unusual. Only a few cases of this uncommon entity have been reported. PRESENTATION OF CASE This report describes a case of acute compartment syndrome following severe inversion of an ankle injury secondary to disruption of the perforating branch of the peroneal artery 3 h after the trauma. Although emergent fasciotomy was performed, residual weakness of ankle dorsiflexion still presented six months after surgery. DISCUSSION To the best of our knowledge, this case is the third in literature on an acute compartment syndrome following severe inversion ankle injury secondary to disruption of the perforating branch of the peroneal artery. CONCLUSION This report underscores the importance of considering compartment syndrome when individual has an inversion ankle injury, even when no fracture exists.
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Affiliation(s)
- Yu-Pin Chen
- Department of Orthopaedic Surgery, Taipei Medical University-Wan Fang Hospital, School of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wei-Pin Ho
- Department of Orthopaedic Surgery, Taipei Medical University-Wan Fang Hospital, School of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Poo-Kuang Wong
- Department of Orthopaedic Surgery, Taipei Medical University-Wan Fang Hospital, School of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
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Mabvuure NT, Malahias M, Hindocha S, Khan W, Juma A. Acute compartment syndrome of the limbs: current concepts and management. Open Orthop J 2012; 6:535-43. [PMID: 23248724 PMCID: PMC3522209 DOI: 10.2174/1874325001206010535] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/07/2012] [Accepted: 09/19/2012] [Indexed: 11/22/2022] Open
Abstract
Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome.
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Perry MD, Manoli A. Reconstruction of the foot after leg or foot compartment syndrome. Crit Care Nurs Clin North Am 2012; 24:311-22. [PMID: 22548865 DOI: 10.1016/j.ccell.2012.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mark D Perry
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-8883, USA.
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Henning A, Gaines RJ, Carr D, Lambert E. Acute compartment syndrome of the foot following fixation of a pilon variant ankle fracture. Orthopedics 2010; 33:926. [PMID: 21162493 DOI: 10.3928/01477447-20101021-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Acute traumatic compartment syndrome of the foot is a serious potential complication after fractures, crush injuries, or reperfusion injury after vascular repair. Foot compartment syndrome in association with injuries to the ankle is rare. This article presents a case of acute compartment syndrome of the foot following open reduction and internal fixation of an ankle fracture. A 16-year-old girl presented after sustaining a left ankle injury. Radiographs demonstrated a length-stable posterior and lateral malleolar ankle fracture. Initial treatment consisted of a bulky splint and crutches pending the improvement of her swelling. Over the course of a week, the soft tissue environment of the distal lower extremity improved, and the patient underwent open reduction and internal fixation of both her fibula and distal tibia through 2 approaches. Approximately 2 hours from the completion of surgery, the patient reported worsening pain over the medial aspect of her foot and into her calcaneus. Physical examination of the foot demonstrated a swollen and tense abductor hallicus and heel pad. Posterior tibial and dorsalis pedis pulses were palpable and her sensation was intact throughout her foot. Emergently, fasciotomy of both compartments was performed through a medial incision. Postoperatively, the patient reported immediate pain relief. At 18-month follow-up, she reported no pain and had returned to all of her preinjury athletic activities.
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Affiliation(s)
- Amy Henning
- Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Virginia, USA
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Kemp MA, Barnes JR, Thorpe PL, Williams JL. Avulsion of the perforating branch of the peroneal artery secondary to an ankle sprain: a cause of acute compartment syndrome in the leg. J Foot Ankle Surg 2010; 50:102-3. [PMID: 21106410 DOI: 10.1053/j.jfas.2010.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Indexed: 02/03/2023]
Abstract
In this report, we describe the case of an adult male who developed an acute compartment syndrome localized to the anterior compartment of the leg following an ankle sprain. Compartment syndrome in association with ankle sprain is unusual, and has been previously described in association with avulsion of the perforating peroneal artery. Because of the potential for severe morbidity, we feel that it is important to make foot and ankle surgeons aware of this unusual injury.
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Affiliation(s)
- Mark A Kemp
- Musgrove Park Hospital, Taunton, Somerset, UK.
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Abstract
Injury to the perforating branch of the peroneal artery has not been reported previously as a cause of acute compartment syndrome following soft-tissue injury to the ankle. We describe the case of a 23-year-old male who sustained such an injury resulting in an acute compartment syndrome. In a review of the literature, we could find only five previous cases, all of which gave rise to a false aneurysm which was detected after the acute event.
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Affiliation(s)
- N J Ward
- John Radcliffe Hospital, Oxford, UK.
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Thrombose de l’artère tibiale postérieure : une complication rare d’un traumatisme fermé de la cheville. ACTA ACUST UNITED AC 2007; 93:599-602. [DOI: 10.1016/s0035-1040(07)92683-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Maurel B, Brilhault J, Martinez R, Lermusiaux P. Compartment syndrome with foot ischemia after inversion injury of the ankle. J Vasc Surg 2007; 46:369-71. [PMID: 17664114 DOI: 10.1016/j.jvs.2007.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2006] [Accepted: 03/02/2007] [Indexed: 10/23/2022]
Abstract
This article reports the case of a 17-year-old girl who presented with compartment syndrome and acute ischemia of the foot after a minor ankle sprain. The suspected cause of compartment syndrome was secondary emergence of swelling and palsy of the foot. The posterior tibial and dorsalis pedis pulses were nonpalpable. The syndrome was confirmed by measurement of the pressures in the compartments of the foot, which were >30 mm Hg. Foot fasciotomy was successfully performed by using a three-incision technique. In contrast with previous case reports, no bone or vessel lesion was detected to explain the onset of a compartment syndrome. To our knowledge, this is the first case report compartment syndrome of the foot after an isolated minor ankle injury. Physicians should be aware of the possibility of compartment syndrome of the foot emerging irrespective of the severity of the initial trauma.
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Affiliation(s)
- Blandine Maurel
- Service de Chirurgie Vasculaire, CHRU de Tours, Hôpital Trousseau, Tours, France
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Reach JS, Amrami KK, Felmlee JP, Stanley DW, Alcorn JM, Turner NS. The compartments of the foot: a 3-tesla magnetic resonance imaging study with clinical correlates for needle pressure testing. Foot Ankle Int 2007; 28:584-94. [PMID: 17559766 DOI: 10.3113/fai.2007.0584] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reliable measurement of subfascial pressures represents an essential part of compartment syndrome management. To date, there is neither consensus on the number or location of foot compartments, nor a standardized protocol for needle placement. The purpose of this study was to devise a new system using 3-Tesla MRI that assesses the number and location of these compartments. METHODS To document the specific location of foot compartments, high resolution 3-Tesla MRI (General Electric, Milwaukee, WI) was coupled with a dedicated transmit-receive high signal-to-noise foot/ankle coil (IGC-Medical Advances, Milwaukee, WI). Individual compartments were highlighted and mapped to T1-weighted MRI. Three-dimensional image analysis allowed standardized needle placement recommendations. RESULTS Six feet from healthy volunteers were imaged. From these, ten compartments were described: (1) medial, (2) central superficial, (3) central deep (adductor), (4) lateral, (5-8) interossei, (9) calcaneal, and (10) skin. Optimal needle placement and depth were identified. CONCLUSIONS The proposed system allowed us to assess the number and location of foot compartments. Computer image analysis enabled us to define exact points for needle insertion and depth of penetration for accurate pressure monitoring.
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Affiliation(s)
- John S Reach
- Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Reach JS, Amrami KK, Felmlee JP, Stanley DW, Alcorn JM, Turner NS, Carmichael SW. Anatomic compartments of the foot: a 3-Tesla magnetic resonance imaging study. Clin Anat 2007; 20:201-8. [PMID: 16944525 DOI: 10.1002/ca.20381] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is neither consensus on the number nor agreement on the location of the anatomic compartments of the foot. This project utilized high-resolution magnetic resonance imaging (MRI) to identify foot compartments. The purpose of this study was to devise a new system using 3-Tesla (3T) MRI that assessed the number and location of these compartments. Six feet from healthy volunteers were imaged. From these, 10 compartments were described: (1) medial, (2) calcaneal, (3) lateral, (4) central superficial, (5) central deep (adductor), (6-9) interossei, and (10) skin. The 3T MRI and foot/ankle coil allowed us to assess the number and location of foot compartments.
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Affiliation(s)
- John S Reach
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
Compartment syndrome should be treated early and aggressively to prevent late complications. Patients may have late deformity because of a failure of diagnosis, inadequate decompression, or a delay in fasciotomies. Late reconstruction will allow a plantigrade and relatively functional foot. Complete excision of scarred muscle will prevent recurrence in established deformities. Early treatment may prevent significant functional impairment by well-placed tenotomies. In patients with severe long-term deformities with extensive soft tissue contraction, incremental correction may be an appropriate intermediate intervention.
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Affiliation(s)
- Mark D Perry
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8883, USA.
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