Compartment Syndrome of the Foot associated with an Open Lisfranc Injury: A case report

Abstract

A high index of suspicion is required to recognize compartment syndrome in both closed and open fractures. 1 Compartment syndrome of the foot is well-described with cases secondary to closed trauma. We present an unusual case of an open Lisfranc fracture with compartment syndrome. Diagnostic modalities are discussed and early diagnosis appears to improve the success of treatment. ompartment syndrome is considered a surgical emergency. When not treated in a timely manner, compartment syndrome can lead to disastrous complications including muscle necrosis, Volkmann's contracture, neurological deficit, crush syndrome, and even death. 1 There are reported cases of associated compartment syndrome in open fractures of the lower leg, however not in the foot. 2 As classically described, compartment syndrome results from increased interstitial pressure in a closed osseofascial compartment, which leads to micro vascular compromise. 3 Typically, interstitial pressures in a closed osseofascial compartment are less than intravenous pressures. This pressure gradient allows the venous system to remain patent. When the interstitial pressure surpasses that of the intravenous pressure the veins collapse and capillary blood flow ceases. This results in swelling and increase compartment pressures. 4 Webber and Manoli identified nine compartments in the foot. Three compartments run the entire length of the foot, five compartments are contained within the forefoot, and a calcaneal compartment. 5 The consensus in the treatment of compartment syndrome is to reduce pressure in order to restore perfusion. Immediate fasciotomy is recommended to prevent long-term complications.