Acute compartment syndrome is a clinical diagnosis, and the earliest reliable signs are pain out of proportion to the injury and pain on passive stretch of the muscles in the affected compartment. Pallor, pulselessness and paralysis are late signs; waiting for them means irreversible muscle and nerve damage. Rising analgesic needs after a tibial or forearm fracture should prompt reassessment. Where the patient cannot be examined reliably, compartment pressure measurement helps.
- Assess pain on passive stretch regularly after tibial and forearm fractures.
- Treat rising analgesic requirement as a warning sign and examine the limb.
- Split casts and dressings down to skin if compartment syndrome is suspected.
- Do not wait for loss of pulses; it is a late sign.
- Measure compartment pressures in sedated or unconscious patients.
Why it matters
Missed compartment syndrome remains one of the most damaging and avoidable complications in fracture care.
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