|
Captain Aman Dhawan, MD
Lt. Col. William C. Doukas, MD ABSTRACT Ankle sprains, especially inversion
sprains, are one of the most common ankle injuries seen.
To date, only one case has been found in the English literature
regarding ankle sprain and resultant compartment syndrome.
This is a case study of a 35 year-old man who sustained a severe inversion ankle sprain while playing basketball. Ninety minutes post injury he saw his primary care provider, who suggested RICE therapy (rest, ice, compression, elevation). 5 hours later, he returned to the physician due to increases swelling and pain. Pneumatic intermittent impulse compression was applied for one hour and the patient was told to resume home rest program. Pain and swelling increased through the night, and the following morning another visit to the PCP revealed a 26 hour-old injury with severe swelling, with circumferential blistering of the skin. An orthopaedic consultation found
decreased light touch and extreme pain with passive dorsiflexion of the
toes. Posterior tibial and
dorsalis pedis pulses were not palpable, but capillary refill was
extremely brisk. Dorsal
compartment pressures measured with a Stryker Guage revealed 120mm
pressure between metatarsals 2-3-4, and the diagnosis of compartment
syndrome was made. Fasciotomy
was performed and 100cc of congealed hematoma was removed after the
musculature bulged through the incision once made.
However, the patient continued to have bleeding and reduced blood
hemoglobin at the 48-hour period. Ateriography
found disruption of the anterior tibial artery at the level of the ankle
joint, but proximal to the region of the surgical incision.
Grafting was performed via the opposite limb saphenous vein by a
vascular surgeon. The patient
had minimal long-term complications, but continued to have loss of skin
pigmentation. The exact reason why this
individual sustained an artery tear is not known. IT has been reported that 3.5% of the population has a
vascular anomaly where the perforating peroneal artery continues as the
dorsalis pedis artery instead of the anterior tibial artery, although this
anomaly was not found in this patient.
However, the condition could lead to this type of injury.
Another injury that can occur with a sprain is a pseudoaneurysm,
which has been reported in the literature at different times, and is
usually treated via embolization, excision, ligation or the branch
involved. COMMENTS A case study that presents some
information that any PT or ATC should be aware of when treating an acute
ankle sprain. The pictures of
the blistering are amazing, and the foot basically looks like that of a
corpse, where the skin is bubbling and blistering as the bacterial gas
expands within the body cavity. How
this person did not sustain any permanent nerve or soft tissue damage is
beyond me. He evidently
returned to aggressive activity, including skydiving, and had full ROM and
strength.
|