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Recurrent Compartment Syndrome in NFL Player

A rare case of recurring acute compartment syndrome (ACS) is reported in a career athlete. On two separate occasions this football player suffered minor trauma to the lower leg. Both times the result was pain, swelling, and loss of motion because of a fracture and swelling.

The first time it happened, the football player was kicked in the left leg during a training camp scrimmage. X-rays and CT scans showed a fracture in a synostosis.

A synostosis is a bridge of bone between the two bones of the lower leg. It is not a normal part of the bone anatomy. It may be present at birth in a small number of children, but usually occurs as a result of trauma.

Bleeding into the area forms a pocket of blood called a hematoma. The hematoma starts to fill in with bone cells. This abnormal process is called ossification. As the bone heals, stressful activity causes tiny fractures within the synostosis. The patient starts to have the symptoms described leading to ACS.

Surgery is needed to release the connective tissue called fascia. The fascia surrounds the muscles in the lower leg. Fluid from the swelling gets trapped inside the fascia and puts pressure on the blood vessels and nerves. Serious problems can occur without surgery to release the fascia. The procedure is called a fasciotomy.

In this case report, the football player had an injury, developed ACS, and was treated with a fasciotomy. The following year he went back to playing and was kicked in the same leg again. Fracture of the synostosis, hematoma, and ACS recurred. Fasciotomy was performed a second time.

After two years this player was back to normal with running, cutting, and jumping. The authors point out that synostotic fractures can lead to ACS. And compartment syndrome can occur even after the patient has already had a previous fasciotomy. Removing the synostosis is an option but other studies report it often grows back.

References: Bryan Hanypsiak, MD, et al. Recurrent Compartment Syndrome After Fracture of a Tibiofibular Synostosis in a National Football League Player. In American Journal of Sports Medicine. Vol. 35. No. 1. Pp. 127-130.

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