Impending Compartment Syndrome in Blunt Leg Trauma Without Fracture: The Importance of Clinical Supspicion

Introduction: Acute compartment syndrome is a limb-threatening emergency most commonly associated with long bone fractures. But it may rarely occur after isolated soft tissue injury without any bony involvement, which can delay recognition and management. Early diagnosis remains primarily clinical and requires a high index of suspicion.

Case Presentation: A 23-year-old male presented with severe left leg pain and swelling after blunt trauma sustained in a road traffic accident. The pain was disproportionate to clinical findings and unrelieved by analgesics. Examination showed tense, tender calf with marked pain on passive stretch and feeble distal pulses. Radiographs showed no fracture. Ultrasound showed intramuscular hematoma in the medial head of the gastrocnemius muscle. Based on clinical findings, a diagnosis of impending compartment syndrome was made. The patient underwent emergency four-compartment fasciotomy. Intraoperatively, edematous but viable muscle tissue and organized hematoma were identified, and clots were evacuated. Postoperatively, distal perfusion improved, and subsequent split-skin grafting was performed with good functional recovery.

Conclusion: Compartment syndrome can develop in the absence of fracture following blunt soft tissue trauma. Classical clinical features—particularly pain out of proportion and pain on passive stretch—should prompt urgent intervention irrespective of radiological findings. Early recognition and timely fasciotomy are critical to prevent irreversible neurovascular damage and ensure limb salvage.