ANTERIOR COMPARTMENT SYNDROME AFTER INVERSION SPRAIN

Objectives: This is a 17-year-old male with no significant past medical history who presented for evaluation after a right inversion ankle sprain he sustained the day prior while playing soccer with continued calf pain. On exam, he exhibited tenderness to palpation over his right calf, mild first web space numbness, and compartment pressures < 30 mmHg. He was evaluated by the Trauma and Orthopedics teams and underwent magnetic resonance imaging (MRI) to rule out ligamentous injury. His MRI was significant for findings of lateral compartment syndrome.
The patient was admitted for pain control and serial exams. Several hours later, his exam worsened, prompting an anterior and lateral compartment fasciotomy. In the operating room, there were findings of anterior compartment syndrome with an avulsed muscle segment and hematoma. He required multiple operative washouts, anterior compartment muscle debridements, wound vac placements and eventual primary wound closure. Upon discharge, the patient had foot droop, which improved with outpatient physical therapy.
Anterior compartment syndrome is a rare development from an inversion ankle sprain. Providers should maintain a high index of suspicion for compartment syndrome when a patient reports calf pain after sustaining an inversion ankle sprain. Though compartment syndrome is a clinical diagnosis, there is a paucity of literature surrounding MRI diagnosis of compartment syndrome.

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