A 40-year-old patient develops acute severe pain, pallor, pulselessness, paraesthesia, and paralysis of the forearm after a closed forearm injury. Compartment pressure measured in the volar compartment is 45 mmHg with a diastolic BP of 75 mmHg (delta pressure = 30 mmHg). What is the immediate management?

• A Emergency fasciotomy of all forearm compartments without delay ✓
• B Elevate the limb and apply ice packs, reassess in 2 hours
• C IV mannitol and acetazolamide to reduce compartment pressure medically
• D Arterial angiography to identify the vascular injury before fasciotomy

Explanation

Acute compartment syndrome is diagnosed when delta pressure (diastolic BP minus compartment pressure) falls below 30 mmHg, or when absolute compartment pressure exceeds 30 mmHg in the presence of clinical signs. The 5 Ps (pain out of proportion, pain on passive stretch, paraesthesia, pallor, pulselessness) indicate ischaemia. Emergency fasciotomy of all forearm compartments (volar, dorsal, and mobile wad) is the only life- and limb-saving treatment; any delay risks permanent Volkmann's contracture or limb loss.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.