Intended for healthcare professionals

Endgames Case Review

A man with severe leg pain

BMJ 2019; 365 doi: (Published 22 May 2019) Cite this as: BMJ 2019;365:l1301
  1. Prateush Singh, core surgical trainee,
  2. Esha Singh, medical student,
  3. Mo Akhavani, plastic surgery consultant
  1. Royal Free Hospital, London, UK
  1. Correspondence to P Singh singh.prateush{at}

A 23 year old man presented to the emergency department after being trapped between two cars and suffering a crush injury to his right leg. Radiography revealed no underlying fractures. One hour after the injury he developed progressively worsening pain in his right leg, which he described as 8/10 in severity. It seemed to be out of proportion to his injury and was worse with both passive and active movement. His right leg became very tense and swollen and he developed paraesthesia in his right foot. Pulses remained palpable and, although painful, he could still actively move his leg and foot. Results of tests he underwent are shown in table 1.

View this table:
Table 1

Results of relevant investigations


  1. What is the diagnosis?

  2. What is the initial …

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