Posters
Presenting Author Academic/Professional Position
Resident
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Medical Education
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Rhabdomyolysis is the breakdown of skeletal muscle tissue that results in the release of intracellular contents such as myoglobin, CK, and electrolytes into the surrounding interstitium and circulation. Rhabdomyolysis is commonly precipitated by trauma, excessive physical exertion, infection, or drug toxicity. Compartment syndrome can be a complication of severe rhabdomyolysis, characterized by increased pressure in a closed anatomical space which can lead to compromised perfusion and ischemia. Timely identification and early surgical intervention are crucial to improving outcomes. Here we present a case of rhabdomyolysis complicated by acute compartment syndrome of the leg in the setting of prolonged poor limb positioning after a ground level fall.
Case Presentation: A 75-year-old lady with unremarkable past medical history presented to our Emergency Department for evaluation after sustaining a ground-level fall in her restroom followed by prolonged (> 2 hours) frog-leg positioning of her lower limbs. Upon arrival, the patient was complaining of excruciating right hip pain. She retained full range of motion on physical examination with no obvious skeletal deformities. Labs obtained revealed marked leukocytosis with WBC of 23.5, elevated renal enzymes with a BUN/Creatinine 29/2.45 respectively, and an elevated creatinine kinase (CK) of 5,800 U/L. The remaining labs were within normal range and imaging studies obtained, including X-rays of the right hip, knee, and foot, were unremarkable with no evidence of acute fracture or dislocation. The patient subsequently was admitted for IVF resuscitation. During the first night, she began experiencing low urine output, worsening paresthesia's, and pain out of proportion in the right leg. On bedside evaluation of the extremity, she was noted to have increased tension, swelling, and weak pulses. Repeat CK level was 189,960 U/L. Due to high suspicion for acute compartment syndrome, orthopedic surgery was paged, and the patient underwent immediate decompression with fasciotomy of the right leg. She underwent secondary and primary wound closure on days five and eleven of admission, after which she was discharged to an inpatient rehabilitation center.
Discussion: Acute compartment syndrome (ACS) is a serious complication of rhabdomyolysis. Prompt recognition is crucial as surgical fasciotomy is the only treatment for salvaging the limb. Diagnosis of ACS represents a challenge for clinicians as symptoms may be ambiguous and overlap those of rhabdomyolysis. Additionally, the diagnosis is often delayed or missed in patients without a fracture. We present the case of an elderly lady without a high-energy injury or fracture who developed rhabdomyolysis-induced kidney injury and right leg compartment syndrome. Clinicians should maintain a high index of suspicion for ACS in patients with rhabdomyolysis regardless of the inciting cause. Diagnosis requires vigilance and serial examinations which can be increasingly difficult in a resource-limited setting without a permanent orthopedic service.
Recommended Citation
Malaga-Espinoza, Barbara; Haj-yahya, Khairiya; and Haines, Corey, "A Case of Rhabdomyolysis Complicated by Acute Compartment Syndrome After a Ground-Level Fall" (2025). Research Symposium. 29.
https://scholarworks.utrgv.edu/somrs/2025/posters/29
Included in
Musculoskeletal Diseases Commons, Pathological Conditions, Signs and Symptoms Commons, Wounds and Injuries Commons
A Case of Rhabdomyolysis Complicated by Acute Compartment Syndrome After a Ground-Level Fall
Introduction: Rhabdomyolysis is the breakdown of skeletal muscle tissue that results in the release of intracellular contents such as myoglobin, CK, and electrolytes into the surrounding interstitium and circulation. Rhabdomyolysis is commonly precipitated by trauma, excessive physical exertion, infection, or drug toxicity. Compartment syndrome can be a complication of severe rhabdomyolysis, characterized by increased pressure in a closed anatomical space which can lead to compromised perfusion and ischemia. Timely identification and early surgical intervention are crucial to improving outcomes. Here we present a case of rhabdomyolysis complicated by acute compartment syndrome of the leg in the setting of prolonged poor limb positioning after a ground level fall.
Case Presentation: A 75-year-old lady with unremarkable past medical history presented to our Emergency Department for evaluation after sustaining a ground-level fall in her restroom followed by prolonged (> 2 hours) frog-leg positioning of her lower limbs. Upon arrival, the patient was complaining of excruciating right hip pain. She retained full range of motion on physical examination with no obvious skeletal deformities. Labs obtained revealed marked leukocytosis with WBC of 23.5, elevated renal enzymes with a BUN/Creatinine 29/2.45 respectively, and an elevated creatinine kinase (CK) of 5,800 U/L. The remaining labs were within normal range and imaging studies obtained, including X-rays of the right hip, knee, and foot, were unremarkable with no evidence of acute fracture or dislocation. The patient subsequently was admitted for IVF resuscitation. During the first night, she began experiencing low urine output, worsening paresthesia's, and pain out of proportion in the right leg. On bedside evaluation of the extremity, she was noted to have increased tension, swelling, and weak pulses. Repeat CK level was 189,960 U/L. Due to high suspicion for acute compartment syndrome, orthopedic surgery was paged, and the patient underwent immediate decompression with fasciotomy of the right leg. She underwent secondary and primary wound closure on days five and eleven of admission, after which she was discharged to an inpatient rehabilitation center.
Discussion: Acute compartment syndrome (ACS) is a serious complication of rhabdomyolysis. Prompt recognition is crucial as surgical fasciotomy is the only treatment for salvaging the limb. Diagnosis of ACS represents a challenge for clinicians as symptoms may be ambiguous and overlap those of rhabdomyolysis. Additionally, the diagnosis is often delayed or missed in patients without a fracture. We present the case of an elderly lady without a high-energy injury or fracture who developed rhabdomyolysis-induced kidney injury and right leg compartment syndrome. Clinicians should maintain a high index of suspicion for ACS in patients with rhabdomyolysis regardless of the inciting cause. Diagnosis requires vigilance and serial examinations which can be increasingly difficult in a resource-limited setting without a permanent orthopedic service.
