A 28-year-old construction worker develops severe pain, paraesthesia, and tense swelling of the forearm 6 hours after a crush injury without apparent fracture. Passive extension of fingers worsens the pain markedly. The most appropriate immediate management is:

• A Elevation and ice application with observation
• B Emergency fasciotomy of all forearm compartments ✓
• C IV mannitol and dexamethasone to reduce swelling
• D Percutaneous compartment pressure monitoring only

Explanation

This is acute compartment syndrome — a clinical diagnosis based on pain out of proportion to injury, pain on passive stretch, paraesthesia, and a tense compartment. When the clinical diagnosis is established, emergency fasciotomy is indicated without waiting for pressure measurements, as a delay beyond 6 hours significantly increases the risk of irreversible ischaemic muscle necrosis and contracture. Elevation is contraindicated as it worsens perfusion pressure.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.