Compartment syndrome is caused by a severe bruise on the lower leg caused by kicking, tackling, etc.
Lower leg compartment syndrome is a disorder in which bruises, fractures, and dislocations caused by sports or traffic accidents increase the pressure in the tissues of the lower leg due to bleeding, resulting in circulatory disturbances of the intramuscular arterioles and death of the musculotendinous nervous tissue. Once the tissue becomes necrotic, disability becomes permanent, so early identification is important. The disease is most common throughout the body, especially in the lower legs (Photos 1 and 2). The lower leg has four small compartments, such as the fascia, that tend to develop increased pressure.
Photo 1 shows the patella facing the front and the lower leg rotating right 90 degrees. Compartment syndrome with marked leg swelling
Photo 2 is an X-ray image of the same case as Photo 1. The tibia and fibula are shown in lateral view with a spiral fracture at the diaphysis, but the ankle is rotated 90 degrees and facing anteriorly.
The figure shows four compartments with the leg cut into whorls.
Cause and mechanism of onset
The lower leg compartment is divided into four compartments (1) anterior, (2) lateral, (3) superficial posterior, and (4) deep posterior depending on the strong fascia. 1) Anteriorly, the tibialis anterior, extensor hallucis longus, and extensor digitorum longus are present; 2) laterally, the long and short muscles of the fibula; 3) superficial posteriorly, the gastrocnemius, soleus, and plantaris; and 4) deeply posteriorly, the posterior tibial muscle, the flexor hallucis longus, and flexor digitorum longus.
Pain, swelling, tenderness, induration, motor pain, sensory paralysis due to intracompartmental nerve palsy, passive movement disorders, and pain during passive movement are observed in each region.
1. Anterior compartment disorders are the most common, with pain, swelling, and tenderness in the anterolateral lower leg, sensory disturbances in the deep fibula area (between the first and second toes), muscle weakness on dorsiflexion of the ankle (tibialis anterior, extensor digitorum), and pain during passive exertion in the plantar flexion of the ankle and toe.
2. Tenderness is lateral in the lateral compartment, with sensory disturbances in the superficial fibula nerve region (lateral lower leg), weakness in the eversion movement of ankle joint (short and long fibula muscles), and pain during passive movement in the inversion movement of ankle joint.
3. In the superficial posterior compartment, tenderness is posterior (calf) and may include sensory disturbances in the sural nerve area, weakness of the plantar flexors (gastrocnemius, soleus), and pain during passive ankle dorsiflexion.
4. In the deep posterior compartment, tenderness is posterior (medial lower leg), and sensory deficits in the area of the tibial nerves (medial plantar), loss of muscle strength of posterior tibial muscle of the ankle or the extensor digitorum pedis, and pain during passive dorsiflexion of the toes are present.
Simple needle manometer procedure is taken that uses a sphygmomanometer or central venous pressure measurement, in which the needles are inserted into different compartments and measured. The disease is considered to be present with a pressure of more than 30 mmHg. X-rays can be used to check for underlying fractures or dislocations. Magnetic resonance imaging (MRI) can show whether a hematoma is present.
Acute cases are more common with skiing, rugby, basketball (when fractures or bruises occur), and chronic cases are more common with long-distance land sports or soccer.
Treatment and rehabilitation
If there is sudden pain, swelling, or deformity, transport the person to a hospital immediately. First aid RICE procedures, such as local immobilization, elevation, and icing, are used. Symptoms of these compartment syndromes can be managed with an understanding of the cause, such as a fracture (reduction of a fracture). Surgery is indicated if internal pressure is greater than 50 mmHg, and consider compartmental fasciotomy (reducing internal pressure) if pressure is greater than 30 mmHg for several hours. The skin and fascia are left open. In chronic cases, exercise should be carefully controlled before and after exercise, including stretching of the tibialis anterior, gastrocnemius, and fibula muscles, avoiding eccentric muscle strength exercises, and focusing on concentric muscle contraction strength training. After the operation, the person is instructed to return to running in about one month.