Acute Compartment Syndrome Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Do clinical signs support it
   Do the clinical signs support compartment syndrome? (Raised pressure in a closed compartment causing ischemic necrosis, a surgical emergency (tibial fracture most common; also reperfusion/crush/tight cast/burns). Clinical diagnosis: pain out of proportion to the injury (earliest), pain on passive stretch (most reliable early sign), tense woody swelling, paresthesia; pallor/pulselessness/paralysis are late irreversible signs, do not wait. If uncertain/comatose, measure pressure: compartment pressure >30 mmHg or delta pressure (diastolic BP minus compartment pressure) ≤30 mmHg.)
   • Clinically supported or measured pressure at threshold → Confirmed → emergency fasciotomy
   • Suspicious, currently uncertain → Suspicious · decompress + monitor
2. [End] Suspicious · decompress + monitor
   Remove all constriction (split casts/dressings), keep the limb at heart level (do not elevate or dangle), analgesia, correct hypotension; close continuous reassessment (stretch pain, tension, sensation), measure compartment pressure in high-risk/comatose patients; fasciotomy immediately if it worsens or delta pressure ≤30.
3. [End] Confirmed → emergency fasciotomy
   Emergency fasciotomy (decompress all involved compartments) is the definitive treatment — ischemia >4–6 h is irreversible, every minute counts. Before surgery: remove constriction, keep the limb at heart level, analgesia and oxygen, correct hypotension. Postoperatively monitor for rhabdomyolysis/myoglobinuria/AKI/hyperkalemia, manage the wound.

Source guidelines & references

• Acute compartment syndrome (UpToDate; StatPearls) - delta pressure ≤30 mmHg threshold

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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