Vol 6 | Issue 1 | Jan-Jun 2020 | page:26-29 | Jun Guang Kendric Tan, Rajitha Gunaratne, Geoff Cooper
Author: Jun Guang Kendric Tan, Rajitha Gunaratne, Geoff Cooper.
 Department of Orthopaedics, Joondalup Health Campus, Grand Blvd &
Shenton Ave, Joondalup, WA 6027.
Address of Correspondence
Dr. Jun Guang Kendric Tan,
Resident Medical Officer, MBBS, Joondalup Health Campus, Grand Blvd &
Shenton Ave, Joondalup, WA 6027.
Acute Compartment syndrome (ACS) is an orthopaedic surgical emergency with very poor prognosis when left untreated. The majority of cases are preceded by trauma, but importantly there is a small percentage of patients presenting with non-traumatic causes. Although rare with only two other case reports describing non-traumatic, spontaneous compartment syndrome of the peroneal compartment, the complications are equally devastating.
We report a 67-year-old female with a history of Factor V Leiden, pulmonary embolism (PE) and deep vein thrombosis (DVT). She was seen by orthopaedic surgery six weeks after acute onset right leg pain with associated foot-drop. Her symptoms were initially managed by a medical team as she had no history of trauma and no fractures were evident on plain radiographs. This was on a background of severe bilateral knee osteoarthritis, chronic bilateral lower leg pain and neurogenic claudication for the preceding six months. Given her atypical presentation with confounding comorbidities, she was admitted under the medical team for further investigations instead of urgent fasciotomy.
As orthopaedics was not involved in the acute phase of her symptoms, a non-surgical approach was taken. MRI right knee and calf six weeks after onset of symptoms were suggestive of sequela of compartment syndrome isolated to the peroneal compartment. This scan showed myonecrosis in this compartment as well as denervation myopathy of the anterior compartment. Over the next twelve months, there was resolution of leg pain and gradual progression of a positive tinel’s sign from the fibular head to anterior shin with associated return of some ankle range of movement and power.
Given the atraumatic presentation and patient risk factors, we believe she suffered a venous thrombotic event at the popliteal trifurcation leading to a subacute compartment syndrome of the peroneal compartment. Swelling of the compartment led to compression of the deep peroneal nerve, causing denervation of the anterior compartment. This is of interest given the rarity of such presentations, and will serve as a timely reminder for non-traumatic causes of ACS.
Keywords: Compartment syndrome, non-traumatic, Factor V Leiden, common peroneal nerve palsy.
1. DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. 1981(160):175-84.
2. Shadgan B, Menon M, Sanders D, Berry G, Martin C, Duffy P, et al. Current thinking about acute compartment syndrome of the lower extremity. Can J Surg. 2010;53(5):329-34.
3. U.S National Library of Medicine. Factor V Leiden thrombophilia Genetics Home Reference2019 [Available from: https://ghr.nlm.nih.gov/condition/factor-v-leiden-thrombophilia#.
4. Corral J, Roldán V, Vicente V. Deep venous thrombosis or pulmonary embolism and factor V Leiden: enigma or paradox. Haematologica. 2010;95(6):863-6.
5. Adrian R. M. Upton AJM. The double crush in nerve-entrapment syndromes. The Lancet. 1973;302(7825):4.
6. Ashton LA, Jarman PG, Marel E. Peroneal compartment syndrome of non-traumatic origin: A case report. J Orthop Surg (Hong Kong). 2001;9(2):67-9.
7. Pentz K, Triplet JJ, Johnson DB, Umbel B, Baker TE. Nontraumatic Compartment Syndrome in a Patient with Protein S Deficiency: A Case Report. JBJS Case Connect. 2018;8(4):e82.
8. Babak S, Matthew M, Peter J., Reid W. Diagnostic Techniques in Acute Compartment Syndrome of the Leg. Journal of orthopaedic trauma. 2008;22:7.
9. Whitesides TEJ HT, Morimoto K, et al. Tissue Pressure Measurements as a Determinant for the Need of Fasciotomy. Clin Orthop. 1975(113):9.
10. Martin B, Martin K, Carsten W, S L. Sequential MR Imaging of Denervated Muscle: Experimental Study. American Society of Neuroradiology. (23):5.
11. Cooley BC, Chen CY, Schmeling G. Increased venous versus arterial thrombosis in the Factor V Leiden mouse. Thromb Res. 2007;119(6):747-51.
12. Makelburg AB, Veeger NJ, Middeldorp S, Hamulyak K, Prins MH, Buller HR, et al. Different risk of deep vein thrombosis and pulmonary embolism in carriers with factor V Leiden compared with non-carriers, but not in other thrombophilic defects. Results from a large retrospective family cohort study. Haematologica. 2010;95(6):1030-3.
13. Juul K, Tybjaerg-Hansen A, Steffensen R, Kofoed S, Jensen G, Nordestgaard BG. Factor V Leiden: The Copenhagen City Heart Study and 2 meta-analyses. Blood. 2002;100(1):3-10.
14. Hirmerova J, Seidlerova J, Chudacek Z. The Prevalence of Concomitant Deep Vein Thrombosis, Symptomatic or Asymptomatic, Proximal or Distal, in Patients With Symptomatic Pulmonary Embolism. Clin Appl Thromb Hemost. 2018;24(8):1352-7.
15. Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, et al. Accuracy of clinical assessment of deep-vei
|How to Cite this article: Tan JGK, Gunaratne R, Cooper G | A Rare Case of Atraumatic Unilateral Isolated Compartment Syndrome of the Peroneal Compartment Leading to Common Peroneal Nerve Palsy | Trauma International | January-June 2020; 6(1): 26-29.|