Postoperative PT notes swollen, warm calf and pain with dorsiflexion after open reduction internal fixation. The MOST likely explanation is which condition?

• A. Compartment syndrome
• B. Deep vein thrombosis
• C. Infection
• D. Peroneal nerve palsy

Answer: (B)

Painful, swollen calf that is warm after lower-limb surgery points to a deep vein thrombosis. The combination fits Virchow’s triad—venous stasis from postoperative immobility, endothelial injury from surgery, and potential hypercoagulability—making a clot in the deep veins likely. Pain with dorsiflexion (often described as a Homan sign) can accompany DVT, though it isn’t perfectly specific; in the postoperative setting, unilateral swelling and warmth are red flags for a clot rather than other conditions.

Compartment syndrome would present with disproportionately severe pain, tense swelling, and pain on passive stretch with potential neurovascular compromise, which is more acute and exam-specific. Infection would usually show wound-related signs or systemic symptoms like fever. Peroneal nerve palsy would cause motor deficit such as foot drop, not primarily calf swelling and warmth.

Thus, the most probable explanation is deep vein thrombosis, which requires urgent medical evaluation and imaging to confirm and guide treatment.