ACUTE COMPARTMENT SYNDROME WITH ATYPICAL PRESENTATION: DELAYED DIAGNOSIS AND FUNCTIONAL OUTCOME. CASE REPORT AND REVIEW OF THE CLINICAL APPROACH
Keywords:
acute compartment syndrome; fasciotomy; delayed diagnosis; extremity trauma; rehabilitation; atypical painAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0873
Abstract
Introduction: Acute compartment syndrome is a surgical emergency caused by increased pressure within an osteofascial compartment, resulting in progressive tissue hypoperfusion and risk of muscle necrosis, neurologic injury, amputation, or death. Although classic findings include pain out of proportion and pain with passive stretch, atypical presentations may occur when pain is mild, fluctuating, masked by analgesia, or difficult to interpret due to altered sensation or communication barriers. Objective: To describe a d clinical case of acute leg compartment syndrome with atypical presentation, delayed diagnosis, and functional sequelae, integrating a narrative review of clinical assessment, diagnostic strategy, therapeutic management, and rehabilitation. Case: A 34-year-old male presented with closed right-leg contusion after a low-energy motorcycle accident and no initial radiographic fracture. He was initially treated as a soft-tissue injury. Eighteen hours later, he developed progressive pain partially controlled with opioids, dorsal foot paresthesia, increased compartment firmness, and weakness of ankle dorsiflexion. The anterior compartment pressure was 54 mmHg and the delta pressure was 20 mmHg. Four-compartment fasciotomy was performed 22 hours after trauma, revealing severe muscle edema and patchy ischemic changes. Secondary debridement, negative-pressure wound therapy, delayed closure, and split-thickness skin grafting were required. At six months, residual deep peroneal sensory loss and mild dorsiflexion weakness persisted, with independent gait and partial return to work. Conclusion: Acute compartment syndrome may have an atypical course with preserved pulses, non-florid pain, or late neurologic findings. High clinical suspicion, serial reassessment, and timely pressure measurement in equivocal cases are essential to reduce diagnostic delay. Functional outcome depends on ischemia duration, timing of decompression, complication control, and multidisciplinary rehabilitation.
Keywords: acute compartment syndrome; fasciotomy; delayed diagnosis; extremity trauma; rehabilitation; atypical pain.
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