Injury, Int. J. Care Injured 31 (2000) 738–739
Case report
Closed avulsion of the Tibialis Anterior: an unusual cause of
compartment syndrome
B. Machani, B. Narayan *, H.B. Casserly
Department of Orthopaedics, Warrington District General Hospital, Warrington WA5 1QG, UK
Accepted 9 March 2000
Numerous causes have been described for acute com-
partment syndrome in the leg. We report an unusual
injury caused by a conveyor belt at work, which led to
a closed avulsion of the Tibialis Anterior from its origin
and the consequent compartment syndrome. In addi-
tion to describing another cause for compartment syn-
drome, this report also highlights the need for
admission and monitoring of all closed ‘soft-tissue’
injuries in the leg.
fasciotomy wounds were apposed with vascular silastic
loops, and were skin-grafted by plastic surgeons 8 days
after the injury. The graft sites healed over the next 2
weeks. The patient had some stiffness of the ankle and
weakness of dorsiflexion but this improved with physio-
therapy, and he regained Grade 4 power of ankle
dorsiflexion after 4 months. He subsequently defaulted
from the clinic.
1. Report
2. Discussion
A 35-year-old male was admitted for observation
when he trapped his leg between a conveyor belt and a
wall at work. He had associated abrasions over the
medial aspect of the popliteal fossa and a puncture
wound on the lateral aspect of his leg. Sensation and
circulation were normal, and he had no bony injury.
He developed increasing leg pain soon after admis-
sion, and a compartment syndrome was clinically sus-
Numerous causes have been described in the litera-
ture for compartment syndromes in the leg. Though
most of these are related to fractures, other important
causes include post-ischemic swelling, osteotomies and
arterial injections.
While reports of closed rupture of the Tibialis Ante-
rior tendon, or the musculotendinous junction exist, a
MEDLINE® search revealed only one similar case [2],
which involved an avulsion of both the Tibialis Ante-
rior and the peroneal muscles. The mode of injury
described in that report is a direct trauma consequent
to a road traffic accident, and the compartment syn-
drome occurred a day after the injury.
The patient in this report trapped his leg between a
moving conveyor belt and a wall, and the movement of
the belt presumably sheared the muscle belly from its
origin, resulting in this unusual injury pattern.
Delay in exploration would have caused further ne-
crosis of the muscle belly. A high index of suspicion is
therefore needed when dealing with such closed injuries,
and we emphasise the need for repeated clinical moni-
toring. Prompt exploration can be associated with a
good outcome.
pected. He therefore underwent
a double-incison
four-compartment crural fasciotomy, as described by
Mubarak and Hargens [1]. On opening the anterolat-
eral compartment, the Tibialis Anterior was noted to be
completely avulsed from its origin. It was found mostly
avascular and rolled up on itself, in the lower half of
the leg. The vascularity improved significantly on
restoring the muscle towards its origin, and a minimal
debridement was perfomed. The muscle was tacked
back to its site of origin, and the wounds left open.
Repeat debridement of the wounds was performed 48
h later, and some necrotic muscle was trimmed. The
* Corresponding author.
E-mail address: badri@bigfoot.com (B. Narayan).
0020-1383/00/$ - see front matter © 2000 Elsevier Science Ltd. All rights reserved.
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