Compartment Syndrome, Leg

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Step 1: View clinicals

A 27 year old man presents with pain in the right calf for one day, and swelling of the same area since morning. The pain started abruptly while he was playing football last evening. There was no history of trauma. He obtained a medical consultation, at which he was prescribed analgesics and sent home. However, the pain worsened over time, and is now severe and present at rest. His medical history is unremarkable.


Step 2: Order all relevant investigations

Renal functions

Urea: 13 mg/dL (0 - 50) S. Creatinine: 1.0 mg/dL (0.5 - 1.5)

Creatine Kinase

10,800 IU/L (45 - 245)

Measure Compartment Pressures

Pressure in compartments of right leg: Anterior: 30 mmHg Lateral: 70 mmHg Deep & Superficial Posterior: 100 mmHg

MRI Right Leg

There is widespread muscle edema in all four compartments. A large hematoma is noted within the body of the gastrocnemius muscle.


Step 3: Select appropriate management

Emergency Fasciotomy
IV Fluids
IV Antibiotics
NSAIDs


Score: ★★☆