By F.N. Khan, A.S.C. Bidwai, and D. Atkinson, Trauma and Orthopaedics, Warrington District General Hospital, Lovely Lane, Warrington, Cheshire, WAS lQG, United Kingdom
Reprinted with permission from Injury Extra, 42(2011) 15-16.

Introduction
Acute limb compartment syndrome is a condition in which raised pressure within a closed fascial space reduces capillary perfusion below a level necessary for tissue viability. When recognized, treatment is urgent surgical decompression of the fascial compartments of the affected limb (Tiwari, Haq, Myint, & Hamilton, 2002).

We present a case of unusual presentation of a patient with acute compartment syndrome of the lower leg treated with
urgent fasciotomy after sustaining a seemingly trivial injury associated with an undisplaced fracture of the fibula.

Case report
A 27-year-old male with no previous medical history presented acutely with pain and swelling of the lower leg. He had tripped over his son's toy and fell directly onto it. He was seen in the emergency department and was discharged home with analgesia the same day. The injury was deemed to be minor in nature and no imaging was performed at that stage. He presented again 24 hours later with the main complaint of numbness on the dorsum of the foot. On examination he was reasonably comfortable at rest, not requiring any painkillers. He had a localized area of swelling and tenderness over the lateral aspect of the lower leg with pain on passive stretching of the muscles in all four compartments of the calf. Anterior and peroneal palpation as well. Moreover, he had parasthesia in the distribution of superficial and deep
peroneal nerve whilst the tibial nerve was spared. Capillary refill was normal and distal pulses were palpable and comparable to the normal side. A radiograph of his left tibia and fibula revealed an undisplaced mid-shaft fracture of the fibula and an incidental finding of a tibial exostosis. The patient was admitted and, after consultant review, was taken
to theatre for urgent fasciotomy for suspected compartment syndrome, the diagnosis being made on clinical grounds.