Addressing Complications After A Gunshot Wound and Compartment Syndrome

A recent poster presented at the American Society of Podiatric Surgeons Conference highlighted a unique case with a novel potential solution.1 They described the case of a 27-year-old male with a gunshot wound to the thigh that developed compartment syndrome necessitating lower extremity fasciotomies and split-thickness skin grafting. For the next year, he experienced increasing pain, numbness, and decrease in dorsiflexion and eversion of the ankle. Electromyography revealed injury to the posterior tibial and peroneal nerves, along with axonal degeneration to the lower extremity consistent with the area of the original compression injury.¹

The authors then described their approach to these complications, which included nerve decompression, Achilles tendon lengthening, and plantar fasciotomy. Focusing on the utility of the nerve decompression and its favorable risk-benefit ratio. Over the year following this intervention, the patient reported improvements in pain, sensation, and range of motion. 

Rose Mary Wilson, DPM, one of the poster’s authors said the team felt this case was particularly unique because foot drop, depending on etiology, is often addressed via tendon transfers.

“However, since tendon transfers cause a decrease in the grade strength of transferred tendons and due to the patient’s presentation, an electromyography (EMG) was ordered,” she added. “The results of the EMG showed axonotmesis of the posterior tibial and peroneal nerves. Despite injury to the axon and its myelin sheath, this type of nerve injury can result in complete recovery.”

Thus, Dr. Wilson shared that the team engaged the patient in a thorough discussion, and successfully performed eventual decompression of the common peroneal, superficial peroneal, and tibial nerves.  

She went on to say that surgeons should emphasize a thorough history and physical to aid in surgical decision making. Additionally, in cases of traumatic injury and compartment syndrome, one must keep anatomical landmarks and variations in mind to avoid neurovascular and muscular complications. Dr. Wilson concluded by stressing the importance of being well-versed in procedures that can address such complications, especially in instances such as that shown in their poster.

“In cases where nerve injury has the potential to be reversed, nerve decompression is a relatively non-invasive procedure with a high potential for improved function,” she explained.   

Reference

Buitrago M, Wilson RM, Schwartz R, Smith C, Hogan B. A novel case study: painful cavus deformity and drop foot secondary to peroneal nerve injury caused by fasciotomies secondary to compartment syndrome from gunshot wound. Presented at the American Society of Podiatric Surgeons Conference. October 2023.