CASE REPORT
COMPARTMENT SYNDROME FOLLOWING ANKLE FRACTURE - A RARE
CASE REPORT
Dinakar Rai1, Parvees C.H2, Chittaranjan3
HOW TO CITE THIS ARTICLE:
Dinakar Rai, Parvees C.H, Chittaranjan. “Compartment Syndrome following ankle fracture - A Rare case
Report”. Journal of Evolution of Medical and Dental Sciences 2013; Vol2, Issue 51, December 23; Page: 1002810031.
INTRODUCTION: Compartment syndrome is commonly reported following tibial fractures and fore
arm fractures. There are only a few case reports of compartment syndrome reported following ankle
fracture. Timely diagnosis and treatment will avoid the devastating complications of compartment
syndrome. Here we report a case of Missed Compartment syndrome of foot following bi malleolar
fracture of Ankle. In this case the diagnosis of compartment syndrome was missed because of rarity
following ankle fracture and associated head injury.
CASE REPORT:An 18 year old male was seen in emergency department immediately following a
RTA. He presented with head injury and deformed ankle, suggestive of a fracture at theankle. He was
disoriented and had a Glasgow coma scale score of 11/15. Ankle examination showed bruises over
the lateral and medial aspect and minimal swelling. Dorsalispedis pulsations were felt at the time of
presentation. As a first aid ankle was immobilized in below knee posterior slab. CT-Brain showed a
sub dural hemorrhage, for which patient was taken up for an emergency decompressive craniotomy
and procedure was performed by neurosurgeon. Post operatively he was put on a ventilator. Ankle
fixation was not done primarily. X ray of ankle was taken bedside after the craniotomy
procedureand revealed a bimalleolar fracture. On the third day of admission it was noticed that he
had an increased swellingin the leg, ankle and foot, with multiple skin blisters. Neurological status
ofthe lower limb could not be assessed since he was on ventilator. Dorsalispedis pulsation was not
palpable and it was thought to be because of subcutaneous edema and tension. Multiple stab
incisions were made around the ankle to relieve the skin tension and edema,ankle was stabilized
with external fixator.
On day 4 when the patient was weaned off the ventilator it was noticed that he had complete
anesthesia on his sole and dorsum of the foot, with incomplete paralysis ofthe foot and leg muscles.
Dorsalispedis pulsation was not palpable at that time also. He was not in pain. On the seventh day
the swelling had subsided and the ankle fracture was treated by open reduction and internal
fixation. Patient was discharged after 2 weeks with persisting sensory deficit and partial paralysis of
foot muscles. Patient followed up in OPD after 1 month with the same neurological status and
contractures at the foot. At that time retrospective diagnosis of missed compartment syndrome with
complication of volkman’s ischemic contracturewas made.
DISCUSSION:“Acute compartment syndrome occurs when pressure rises within a confined space in
the body, resulting in a critical reduction of the blood flow to the tissues contained within the space”
1. Compartment syndrome of the leg and foot are relatively common following distal femoral and
tibial fractures 1, 4. Here we report a rare case of missed compartment syndrome following an ankle
fracture. The diagnosis was further complicated by the presence of an associated head injury and the
Journal of Evolution of Medical and Dental Sciences/Volume 2/Issue 51/ December 23, 2013
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CASE REPORT
rarity. The absent pulsations were thought to because of subcutaneous edema which made difficulty
in palpation. Moreover patient was out of pain which may be because of already established
compartment syndrome and damage to the nerve tissues. Multiple skin punctures were made which
relieved the skin tension and patient was taken up for definitive procedure. If the neurological
defecit was because of skin tension by subcutaneous edema, it would have improved atleast at the
time of review. Since patient had persisting neurological deficit and contracture it was diagnosed to
have volkman’s contracture which is definitely a well-known complication of established
compartment syndrome.There are only a few case reports of compartment syndrome of leg and foot
following ankle fractures. Adam m star et al reported an isolated anterior compartment syndrome
following a bimalleolar ankle fracture 3. Joseph.j et al also reported compartment syndrome
following an isolated ankle fracture7. Seyehi A et al reported an unrecognized anterior compartment
syndrome following ankle fracture surgery9.
CONCLUSION: Compartment syndrome can also occur following ankle fracture and high degree of
suspicion should be required to diagnose compartment syndrome following ankle fracture. In
patients with head injury compartment pressure monitoring may be required to diagnose
compartment syndrome.
Images showing multiple blisters over the
distal leg and managed with Ex fix
Journal of Evolution of Medical and Dental Sciences/Volume 2/Issue 51/ December 23, 2013
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CASE REPORT
Xray right ankle PA and Lat: taken postoperatively after ORIF
REFERENCES:
1. Rockwood and Green’s: text book of fractures in adults; Ankle fractures.
2. Ashworth M, Patel N. compartment syndrome following ankle dislocation, a case report. J
orthop trauma 1998;12:67-68.
3. Adam M star et al- isolated anterior compartment syndrome after a bimalleolar equivalent
ankle fracture, 2011 nov; 3(6):560-563.
4. Campbell’s operative orthopaedics; eleventh edition; chapter compartment syndrome.
5. Bosworth Dm. fracture dislocation of ankle with fixed displacement of fibula behind the tibia,
jbjs Am- 1947;29:130-135.
6. Hawkins B, Bays P. Catastrophic complication of simple cast treatment.a case report, j – trauma
-1993 ;34:760-762.
7. Joseph J.Giamoudis P, Hinschece A et al. compartment syndrome following isolated ankle
fracture.intorthop 2000;24:173-175.
8. Whitesides TE, Hedeman MM. acute compartment syndrome:update on diagnosis and
treatment.j Am Acadorthop surg:1996;4:209-218.
9. Seyahi A, Uludag S, Akman S, Deminham M. unrecognized anterior compartment syndrome
following ankle fracture surgery: a case report. J Am podiatry Med Asso. 2009 sep-oct ;99:438442.
Journal of Evolution of Medical and Dental Sciences/Volume 2/Issue 51/ December 23, 2013
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CASE REPORT
AUTHORS:
1. DinakarRai
2. Parvees C.H.
3. Chittaranjan
PARTICULARS OF CONTRIBUTORS:
1. Professor and HOD, Department of
Orthopaedics,
PSG
Medical
College,
Coimbatore, India.
2. Senior Resident, Department of Orthopaedics,
PSG Medical College, Coimbatore, India.
3. Associate
Professor,
Department
of
Orthopaedics,
PSG
Medical
College,
Coimbatore, India.
NAME ADRRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Parvees C.H.,
Senior Resident,
Department of Orthopaedics,
PSG Medical College,
Coimbatore, India – 641004.
Email –parveesch@gmail.com
Date of Submission: 27/11/2013.
Date of Peer Review: 28/11/2013.
Date of Acceptance: 09/12/2013.
Date of Publishing: 19/12/2013
Journal of Evolution of Medical and Dental Sciences/Volume 2/Issue 51/ December 23, 2013
Page 10031