Acute compartment syndrome after a tibial or forearm fracture is a clinical diagnosis, and the classic late signs come too late. Pulselessness and paralysis appear after muscle has already been lost.
The early signs are pain out of proportion to the injury, rising analgesic requirement, and pain on passive stretch of the muscles in the affected compartment. In a patient who cannot report pain reliably, such as one who is sedated, intubated or under a regional block, measuring compartment pressure is the safer route. Once suspected, split dressings and casts down to skin and keep the limb at heart level, not elevated.
- Ask about pain out of proportion and rising analgesic needs after tibial and forearm fractures.
- Test pain on passive stretch of the compartment's muscles at every review.
- Do not wait for pulselessness or paralysis; they are late signs.
- Split casts and dressings to skin and keep the limb at heart level once suspected.
- Consider compartment pressure measurement when the patient cannot report pain reliably.
Why it matters
Hours count: fasciotomy done late cannot save muscle that has already died.
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