Worsening Leg Pain In A Collegiate Football Player - Page #4
 

Working Diagnosis:
Traumatic Left Lower Extremity Acute Compartment Syndrome due to Proximal Avulsion of the Peroneus Longus Muscle.

Treatment:
Removal of all external pressure on the compartment

Elevation of left leg above the level of the heart

Oxygen via nasal cannuli

Intraoperative Findings: A four compartment fasciotomy was performed. Complete avulsion of the peroneus longus muscle from the proximal component down to the tendinous junction was present. The peroneus longus muscle appeared to be nonviable until it’s distal end where it was cut and removed.Case Photo #1, Case Photo #2

Outcome:
He did well after the fasciotomy and was discharged home 4 days later. At 3 weeks status-post fasciotomy, he was noted to have full range of motion as well as good strength in his left ankle and foot and was cleared to begin training on a stationary bike. He tolerated this well and was progressed to jogging 3 days later. At 4 weeks status-post fasciotomy he progressed to sprinting and tolerated it well. We continued to progress him through cutting and sport specific drills. He was cleared to participate in full contact football at 6 weeks status post fasciotomy.

Editor's Comments:
This case demonstrates the importance of proper triage on the sidelines. The condition of the athlete was worsening and there was pain out of proportion to what was expected. Prompt transfer and evaluation in the emergency department allowed for a good outcome.

References:
Stracciolini, A. Hammerberg, M. Acute Compartment Syndrome of the Extremities In: UpToDate, Grayzel, J (Ed), UpToDate, Waltham, MA, 2013.

Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br 2003; 85:625.

Gabisan GG, Gentile DR. Acute peroneal compartment syndrome following ankle inversion injury: a case report. Am J Sports Med 2004; 32:1059.

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