Compartment Syndrome & Vascular Injury
Recognise evolving limb ischaemia and avoid false reassurance from preserved pulses.
Quick revision ↓ Medical Dictionary
01Pressure and perfusion
Acute compartment syndrome occurs when pressure threatens perfusion within a muscle compartment. Fractures, crush injuries and reperfusion can cause it, including with an open wound. The diagnosis is time-critical; delay can lead to irreversible muscle and nerve injury.
02Clinical suspicion
Increasing pain out of proportion to the expected course, pain with passive stretch and rising analgesic requirement are warning findings. Sensory or motor changes may develop. Findings can be difficult to assess in an unconscious patient, a young child or someone with altered sensation, requiring a specific surveillance plan.
03Pulses and measurements
A pulse can remain palpable despite dangerous compartment pressure. Do not wait for pulselessness or paralysis to seek urgent surgical review. Pressure measurement can support uncertain assessment, especially when examination is unreliable, but must be interpreted with perfusion pressure and clinical context rather than one isolated number.
04Immediate escalation
Obtain urgent senior surgical assessment and address external constriction through the trained clinical team. Keep reassessing circulation and pain while definitive management is arranged. Confirmed acute compartment syndrome generally requires emergency decompression; routine imaging must not create delay in a convincing presentation.
05Arterial injury
A cold poorly perfused limb, absent pulses, active arterial bleeding or an expanding haematoma requires urgent vascular assessment. A spontaneously reduced dislocation can still have arterial damage. Document findings and communicate transfer needs early; restoring skeletal alignment does not by itself prove vascular safety.
High-Yield Revision
- Preserved pulses do not exclude compartment syndrome.
- An unreliable examination needs planned surveillance.
- Dislocations may damage arteries even after reduction.
Common Pitfalls
- Waiting for paralysis before escalating.
- Using one pressure reading without clinical context.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.