A 25-year-old man sustains a closed tibial shaft fracture in a motorcycle accident. Six hours later, he has severe pain out of proportion to injury, pain on passive stretching of toes, and a tense calf. Compartment pressure is measured at 40 mmHg with a diastolic blood pressure of 70 mmHg. What is the definitive management?
- A Elevate the limb and administer mannitol
- B Apply a Doppler ultrasound to assess arterial flow
- C Emergency fasciotomy of all four leg compartments ✓
- D Observe for 12 hours and repeat compartment pressure measurement
Correct answer: C. Emergency fasciotomy of all four leg compartments
Explanation
Compartment syndrome is diagnosed clinically and confirmed by compartment pressure measurement. A compartment pressure >30 mmHg or a delta pressure (diastolic minus compartment pressure) <30 mmHg indicates compartment syndrome requiring emergency fasciotomy. Here, delta pressure is 70-40 = 30 mmHg, which is at threshold, combined with classic clinical signs. Fasciotomy of all four leg compartments is definitive. Mannitol and elevation are not substitutes for fasciotomy.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.