Open fracture of tibia mid-shaft associated with the contralateral leg acute compartment syndrome without fracture

Abstract

The acute extremity compartment syndrome is caused by increased compartment volume or restriction of compartment size. There are 23% of all compartment syndrome is caused by isolated soft-tissue injury especially in crushing injury. We report a 30-year-old male with the initial diagnosis of the right tibia open fracture, Gustilo Type II, due to a motor-vehicle accident. Besides the right leg condition, he was continually suffered from left leg pain, where the X-ray revealed no apparent fracture since the collision. The physical examination showed no skin lesion and deformity; however, numbness and tightness were noted, toe stretching pain+, Pedis Dorsalis Artery+, Posterior Tibialis Artery+. Doppler showed the presence of PDA and PTA blood flow. Nine hours after the injury, pain and numbness of his left leg and foot still persisted and also pale and pulseless developed. Doppler for his left leg was done again and showed the negative result of PTA and PDA. Emergent bilateral side fasciotomy for his left leg was arranged, and the cardiovascular department was consulted for intraoperative angiography. The fasciotomy wound was cared with sterilized saline wet dressing for 3 days. Medial fasciotomy was closed with delayed primary method, and the lateral sides were treated with split-thickness skin graft. Acute compartment syndrome is diagnosed by the interpretation of a collection of clinical signs and symptoms. In a patient with a swollen limb, in the absence of a fracture and for whom, there is a suspicion of an acute compartment syndrome, methods, technology, and application for the early detection of acute compartment syndrome is important and also provides promising opportunities for the clinicians to perform early interventions.

Keywords

• Absence of fracture
• acute compartment syndrome
• early detection
• fasciotomy
• trauma