Compartment Syndrome

• High-risk settings: tibial shaft / plateau, crush, reperfusion, tight casts, burns, coagulopathy
• Early: pain out of proportion, tense compartments, pain with passive stretch
• Later: paresthesias, weakness, pulselessness (too late)
• Remove casts / dressings that constrain the limb
• Pressure measurement supports uncertain cases; a clear clinical picture does not need permission from a dial

If you are arguing with yourself about whether this is compartment syndrome, escalate. Document serial exams with times. A single reassuring exam does not close the case in a rising risk window.

ΔP (diastolic − compartment pressure) thresholds are used when measurement is needed, but clinical judgment still wins. Once committed, fasciotomy must be adequate — incomplete releases fail patients.

• Urgent four-compartment fasciotomy for the leg when indicated (and the correct releases for other regions)
• Leave wounds open initially; plan for delayed closure or coverage
• Address the fracture / cause after (or with) decompression
• Avoid elevating a limb with suspected ACS above heart level in a way that lowers perfusion pressure further

• Clinical diagnosis first
• Pain out of proportion + pain with passive stretch
• Pulselessness is a late finding
• Inadequate fasciotomy is a classic failure mode