Lateral Compartment Syndrome From Inversion Injury

A 17-year-old male presented for the evaluation of right calf pain after an inversion ankle sprain sustained while playing soccer 24 hours prior. On exam, he exhibited swelling and tenderness to palpation over his right calf, mild first web space numbness, and compartment pressures <30 mmHg. Magnetic resonance imaging was significant for findings of lateral compartment syndrome (CS). Upon admission, his exam worsened, prompting an anterior and lateral compartment fasciotomy. Intraoperative findings were significant for lateral CS, with findings of avulsed, nonviable muscle with associated hematoma. Postoperatively the patient had mild foot drop, which improved with physical therapy. Lateral CS rarely develops from an inversion ankle sprain. This presentation of CS is unique due to its mechanism, delayed clinical presentation, and limited signs of CS. Providers should maintain a high index of suspicion for CS in patients with this injury complex and continued pain beyond 24 hours without signs of ligamentous injury.