Presentation
The patient presented with a massive mass involving the anterior and lateral compartments of the right leg, decades after initial trauma in sequelae of femoral diaphysis fracture with neurovascular damage (peroneal nerve palsy) and development of compartment syndrome with foot drop. The patient has been walking with a shorter and deformed limb since the trauma. Soft tissue sarcoma was initially suspected.
Patient Data
Outcomes of fracture of the distal femoral diaphysis treated with osteosynthesis. The two ends of the broken bone are not aligned properly with the leg length discrepancy because the right lower limb is approximately 3 cm shorter than the contralateral one.
Radiographs show sheetlike calcification oriented through the muscles in anterior and lateral compartments of lower limb consistent with calcific myonecrosis.
Coarse calcifications are oriented in a sheet-like and linear pattern, at the periphery in the anterior and lateral muscle compartments.
Case Discussion
Calcific myonecrosis is a rare complication of the leg after trauma, mainly in the muscles of the lower leg, such as the tibialis anterior, peroneus longus, extensor hallucis longus, following trauma with fracture of the fibula, fracture of the tibia, fracture of the femoral shaft followed by ischemic symptoms, rupture of the femoral artery accompanying ischemic muscle necrosis, peripheral nerve injury (common peroneal nerve). It is often the late consequence of acute compartment syndrome with central liquefaction of the muscle belly and subsequent peripheral calcification of the entire muscle. The anterolateral compartment of the leg is a usual site, affecting the tibialis anterior muscle and peroneal muscle. The lesion typically involves one limb but sometimes both limbs may be affected.
Case courtesy Dr. Fabio Denicolò
Radiographers: TSRM Pasquale Casaburi, TSRM Nunzio Bianco, TSRM Simone Pasini
Unable to process the form. Check for errors and try again.