Severe Right Leg Pain After Tibia Fracture

Abstract

A 30-year-old male is brought to the emergency department by paramedics after a motorcycle accident. He has an obvious deformity of the right lower extremity below the knee. Imaging reveals a fracture of the tibia and fibula. He is taken to the operating room for an open reduction and internal fixation (ORIF). Approximately 8 hours after surgery, the patient complains of severe pain in his right leg. On physical examination, the right leg is tensely swollen. He endorses severe tenderness on palpation, especially lateral to the tibia. When his ankle is passively dorsiflexed, he grimaces in pain. His foot appears pink and well perfused. Pulses in the dorsalis pedis and posterior tibial are 2+ and Doppler interrogation demonstrates biphasic signals in both arteries. Sensory exam of the right foot is intact except for numbness in the first web space.