Acute compartment syndrome: A case report for pre-clinical students’ learning & associated small group worksheet

Abstract

Introduction: Acute compartment syndrome is a limb-threatening, orthopedic surgical emergency that is often a result of trauma with associated edema and increased pressure that has limited room for expansion due to the compartments of a limb. During pre-clinical years of medical school, the emphasis on musculoskeletal (MSK) ailments, including acute compartment syndrome, can be limited. It is therefore important to provide case reports that highlight even routine cases of traumatic MSK problems to the learning mind, as repetition is the key to learning. Small group worksheets were utilized during pre-clinical learning sessions, which further play a role in the learning process by forcing students to brainstorm solutions before answers are revealed, and can thus also be utilized to better understand MSK disease.

Case Description: A male patient in their teens presented to the emergency department following an open fracture of his tibia and fibula after getting his leg stuck between a lawn mower and tree. On the day of injury, surgery was done for intramedullary fixation and distal tibia nailing. Post-op day one, early in the morning, the patient began complaining of mild pain and paresthesia of his toes and plantar foot, however had preserved motor function and brisk capillary refill. Compartments of the lower leg were swollen but not tense. A few hours later, the patient had increased pain with passive stretch, paresthesia up to his knee, and tense anterior compartment. The decision was made to do an emergent fasciotomy. The surgery was uncomplicated, but the post-op course was complicated by incision site infection. The patient has been progressing well and undergoing physical therapy with no gross motor or sensory deficits.

Discussion: Acute compartment syndrome can be a rapidly progressing injury, and it is therefore vital to keep it high on the differential in patients complaining of pain with passive stretch and paresthesia. Serial physical exams with this patient ensured the fasciotomy was not delayed. While this report is a classic example of acute compartment syndrome, it can aid in the education of preclinical students. Next steps include incorporating this case and worksheet into MSK curriculum to determine if it leads to improved scores on standardized MSK exams.