Atraumatic Isolated Peroneal Compartment Syndrome: A Case Report

Abstract

Acute compartment syndrome (ACS) is a surgical emergency that is frequently brought on by trauma and is characterized by increased pressure inside a closed osteofascial compartment. However, because of its unusual presentation and absence of acute trauma, atraumatic ACS, especially when isolated to the peroneal compartment, is uncommon and challenging to identify. We describe a case of a 24-year-old man who had no prior history of direct trauma and who presented with atraumatic left leg discomfort and swelling after physical activity. At another hospital, muscle cramps were initially diagnosed, but as symptoms worsened, additional testing was necessary. Physical examination showed a hard lateral compartment, loss of dorsiflexion, and decreased feeling over the dorsum and lateral portions of the foot. Laboratory investigations showed increased creatinine kinase (CK) and myoglobin levels. No bone pathology was visible in the radiographic imaging. Surgical decompression via fasciotomy revealed necrotic peroneal muscles and a hematoma collection. The patient underwent staged debridement and wound management, eventually achieving wound closure and functional recovery with physiotherapy. Six-month follow-up showed restored muscle power. This case emphasizes the importance of considering ACS in atraumatic leg pain and swelling, particularly when CK levels are elevated.