Acute Compartment Syndrome of the Leg Following Injury to Perforating Branch of Peroneal Artery After a Severe Ankle Sprain in a Pediatric Patient – A Case and a Review of Literature

INTRODUCTION: Acute compartment syndrome (ACS) of the leg is seen most often following severe fractures, crush injuries, burns, tight casts, or dressings but rarely after ankle sprains. Very few cases have been found in the literature of compartment syndrome developing after ankle ligament disruptions. We report a case of ACS secondary to an ankle sprain in a 10-year-old child. CASE REPORT: A 10-year-old girl presents to the emergency department after jumping on an in-ground trampoline and slipping onto the surrounding grass and twisting her right ankle. This was followed by immediate swelling of her ankle. In the emergency department, her examination was notable for compartment syndrome. Although there was significant swelling around the ankle, she had good pulses in dorsalis pedis and posterior tibial vessels and normal sensations in her foot. A radiograph demonstrated an undisplaced fracture of medial malleolus with possible disruption of lateral ligament complex of the ankle. The patient was admitted, and the leg became more swollen the following morning with significant increase in pain levels and foot turned cold and purple with weak pulses. She had a delayed capillary refill time and reduced sensation in common peroneal nerve distribution over lateral aspect of foot and tense anterior and lateral compartments of the leg. Therefore, she was taken to theater and a standard open fasciotomy of the leg was performed through a longitudinal incision on the lateral side of leg and compartments decompressed. Fasciotomy revealed a large hematoma in the leg extending into the ankle joint and an avulsed perforating branch of peroneal artery. Postoperatively pain improved, passive toe stretching was no longer painful and she was immobilized in a below-knee plaster cast. CONCLUSION: ACS of leg is often associated with high-energy trauma and rarely seen after ankle injuries. To the best of our knowledge, this is the first reported case of compartment syndrome developing in a pediatric patient following inversion sprain of ankle, leading to rupture of perforating peroneal vessel in the leg.