Isolated Fibula Fracture With Development of Acute Compartment Syndrome

Compartment syndrome is an orthopaedic emergency with moderate-to-severe sequela (pain, muscle contracture, nerve damage, infection, rhabdomyolysis, renal failure, etc.) if inadequately treated and can be difficult to diagnose in a timely fashion. Further complicating timely diagnosis are atypical presentations resulting in compartment syndrome. This case concerns a 31-year-old man who presented with isolated left closed transverse fibular shaft fracture after being a pedestrian struck by a high-speed motor vehicle. He was not on any anticoagulation at the time of the accident. Initial examination 1 hour after arrival was concerning for compartment syndrome because of firm lower extremity compartments, and intracompartmental pressures met criteria for the diagnosis of acute compartment syndrome. He was emergently taken for dual-incision, four-compartment fasciotomy 3 hours after arrival. This case report demonstrates a presentation of acute compartment syndrome in the absence of tibia fracture or risk factors such as anticoagulation. Clinical suspicion of acute compartment syndrome based on physical examination findings warrants close monitoring and possible compartment release even with atypical presentations such as an isolated fibula fracture, high-energy soft-tissue injuries, or crush injuries.