01Approach to the Critical Patient/attcp48

Immediate stabilization

›Time-critical recognition triggers

›Pain out of proportion to injury — most important early sign

›Escalating and refractory to analgesics

›In children: anxiety, agitation, increasing analgesic requirements (3 A's)

›Pain with passive finger extension (volar compartment)

›Sensitivity reported up to 77% for clinical diagnosis

›Most reliable early physical finding

›Progressive paresthesias in median or ulnar nerve distribution

›Indicates ischemic nerve dysfunction

›Early finding; motor deficits are late and may indicate irreversible damage

›Tense, woody-feeling forearm on palpation

›Compartment pressure rising above perfusion threshold

›Irreversible muscle and nerve damage can occur within 6 hours of impaired perfusion

›Immediate interventions

›Remove all circumferential dressings, casts, and splints immediately

›American College of Surgeons Best Practices recommendation

›Can reduce compartment pressure by up to 65%

›Position limb at heart level — not elevated, not dependent

›Elevation above heart reduces perfusion pressure

›Dependency increases edema

›Emergent orthopedic or hand surgery consultation for fasciotomy

›Only definitive treatment

›Optimal timing within 8 hours of onset

›IV access and fluid resuscitation if rhabdomyolysis suspected

›Target urine output 200–300 mL/hr with myoglobinuria

›NPO status — anticipate emergent surgical intervention

02History/hx55

Mechanism and onset

›Traumatic causes

›Fractures — most common cause

›Distal radius fracture — especially with >35% translation or ipsilateral elbow injury

›Both-bone forearm fractures — crush injury OR ~11 for ACS

›Supracondylar fracture in children

›High-energy mechanisms

›Crush injuries

›Penetrating injuries

›Brachial artery injury with reperfusion

›Non-traumatic causes

›Narcotic overdose / "found down" positioning

›Prolonged limb compression during unconsciousness

›10% of forearm ACS cases in systematic review

›IV infiltration or extravasation

›8% of forearm ACS cases in systematic review

›IV drug use (risk for prolonged immobility and vascular injury)

›Bleeding diathesis or anticoagulation

›Spontaneous compartment hemorrhage

›Warfarin, DOACs, heparin use

›Reperfusion injury after arterial repair

›Post-vascular surgery or revascularization

Pain characterization

›Pain trajectory — most important historical feature

›Initially controlled, then escalating and refractory to analgesics

›Increasing opioid requirements are a diagnostic clue — do not mask with blocks

›Escalating analgesic requirement in children: anxiety and agitation

›Onset typically within hours of inciting event

03Physical Exam/exam44

Forearm assessment

›Inspection findings

›Forearm swelling and skin tension

›Ecchymosis, blistering over tense compartments

›Cast or dressing constriction — identify and remove immediately

›Skin appearance over dorsal and volar surfaces

›Shiny, taut skin indicates significant swelling

Neurovascular exam

›Nerve distribution testing

›Median nerve

›Sensation: volar thumb, index, middle finger, radial ring finger

›Motor: thenar strength (opposition, abduction)

›Ulnar nerve

›Sensation: volar/dorsal small finger and ulnar ring finger

›Motor: intrinsic hand muscles, interossei strength

›Radial nerve (posterior interosseous branch)

›Wrist extension and finger extension

›Sensory: dorsal first web space

›Paresthesias — early finding

›Motor deficits — late finding indicating likely irreversible damage

›Vascular exam

›Radial pulse assessment

›Typically preserved until ICP exceeds systolic BP — do NOT use to rule out ACS

›Ulnar pulse assessment

›Capillary refill time

›Presence of pulses does NOT exclude ACS

›Doppler assessment if pulses diminished

04Differential Diagnosis/ddx35

Life-threatening mimics

›Acute arterial occlusion / ischemia

›ICD-10: I74.2 (embolism and thrombosis of arteries of upper extremities)

›Pulselessness more prominent and occurs earlier

›Doppler and CT angiography differentiate

›Pallor, cold extremity more prominent than in ACS

›Necrotizing fasciitis

›ICD-10: M72.6

›Skin changes: erythema, bullae, crepitus, woody induration tracking along fascia

›Systemic toxicity prominent (fever, hypotension, leukocytosis)

›CT neck/extremity for gas in soft tissue planes

Fracture-related differential

›Fracture pain without ACS

›ICD-10: S52.509A (forearm fracture, unspecified)

›Pain should improve with immobilization and appropriate analgesia

›ACS: pain escalates and becomes refractory despite analgesia

›Rhabdomyolysis without ACS

›ICD-10: M62.82

›Elevated CK, myoglobinuria, but no tense compartment

›No pain with passive stretch

Vascular and soft tissue mimics

›Deep vein thrombosis of upper extremity

›ICD-10: I82.891

›Swelling and pain but typically less acute in onset

›Ultrasound: non-compressible vein, absence of flow

›No pain with passive stretch, no tense compartment

›Cellulitis

›ICD-10: L03.119

05Laboratory Tests/lt40

Essential labs

›Creatine kinase (CK)

›Elevated in rhabdomyolysis — key muscle injury marker

›CK >669 U/L identified as predictive cutoff for ACS in forearm fractures

›Serial monitoring every 6–8 hours recommended

›Peak CK typically at 24–48 hours after injury

›Very high CK (>10,000 U/L) — high risk for acute kidney injury

Metabolic panel

›Basic metabolic panel

›Potassium

›Hyperkalemia from muscle necrosis — potentially life-threatening

›ECG if K+ >5.5 mmol/L

›Creatinine and BUN

›Acute kidney injury from myoglobin-induced tubular damage

›Baseline and serial monitoring

›Bicarbonate

›Metabolic acidosis from tissue ischemia and rhabdomyolysis

›Glucose

›Baseline and treatment guidance

Urinalysis

›Urine assessment for myoglobinuria

›Positive blood on dipstick without RBCs on microscopy

›High suspicion for myoglobinuria — nephrotoxic

›Urine myoglobin level if available

›Urine color

›Dark/tea/cola-colored urine strongly suggests myoglobinuria

›Urine output monitoring

›Target 200–300 mL/hr with active myoglobinuria

06Diagnostic Tests/dt87

Scoring Systems

›Delta pressure (ΔP) calculation — primary diagnostic threshold

›ΔP = diastolic blood pressure − intracompartmental pressure

›ΔP <30 mmHg: fasciotomy indicated

›Preferred over absolute ICP threshold

›More physiologically meaningful as it reflects perfusion gradient

›American College of Surgeons Best Practices recommend this threshold

›Absolute ICP threshold

›ICP >30 mmHg alone is less reliable and may lead to unnecessary fasciotomies

›Most useful when used together with ΔP

›Clinical diagnosis criteria — no validated scoring system for ACS

›Pain out of proportion to injury (most sensitive early feature)

›Pain refractory to analgesics

›Escalating analgesic requirements

›Pain with passive stretch of forearm muscles

›Progressive paresthesias in nerve distribution

›Tense compartment on palpation

›Classical 5 P's (pain, pallor, pulselessness, paresthesia, paralysis)

›More indicative of arterial ischemia than ACS

›Pulselessness and paralysis are late, often irreversible findings in ACS

Intracompartmental Pressure Measurement

›ICP measurement device and technique

›Stryker intracompartmental pressure monitor — most commonly used device

›Slit catheter technique preferred for accuracy

›Wick catheter alternative

›Measurement location

›Within 5 cm of the fracture site

›All three compartments must be measured (volar, dorsal, mobile wad)

›Normal forearm compartment pressure approximately 8 mmHg in adults

›Indications for ICP measurement

›Clinical exam equivocal or unobtainable

›Obtunded, sedated, intoxicated, or pediatric patient

›Regional anesthesia or nerve block in place

›Continuous pressure monitoring

›More accurate than single measurements

›Preferred when available in high-risk patients

›Near-infrared spectroscopy (NIRS)

›Emerging noninvasive modality measuring tissue oxygen saturation

›Not yet standard of care

›Promising as adjunct to ICP measurement

Scoring Systems (continued 1)

›Compartment syndrome risk stratification tools

›No universally validated scoring system for ACS diagnosis

›Clinical and pressure-based diagnosis remains gold standard

›Research ongoing for biochemical and imaging-based tools

›Risk factors identified in forearm fracture cohorts (Shaikh et al., 2026)

›CK >669 U/L

›Neutrophil count >7.01/L

›Low albumin

›Crush injury mechanism

MRI

›MRI role in forearm compartment syndrome

›Not indicated in acute setting

›Time requirements incompatible with surgical emergency

›Clinical and pressure-based diagnosis should not be delayed for MRI

›Delayed or subacute use

›Assessment of muscle viability after missed or delayed diagnosis

›Quantify extent of muscle necrosis

›T2 signal hyperintensity and loss of normal muscle architecture

›Volkmann contracture workup

›Characterize fibrotic muscle replacement in chronic sequelae

›Guides reconstructive surgical planning

CT

›CT angiography indications

›Suspected brachial artery injury

›Penetrating injury trajectory near neurovascular bundle

›Absent pulses or significant pulse differential

›Post-vascular repair monitoring

›CT angiography performance

›High sensitivity and specificity for arterial injury

›Differentiates vascular occlusion from compartment syndrome

›CT forearm (plain)

›Not primary diagnostic tool for ACS

›Can identify hematoma size and location

›May show soft tissue gas if necrotizing fasciitis in differential

›Imaging should never delay treatment

›ACS is a clinical and pressure-based diagnosis

›Operative decision not contingent on CT findings

Ultrasound

›Point-of-care ultrasound (POCUS) role

›Hematoma identification

›Echogenic or heterogeneous fluid collection within or adjacent to compartment

›Can quantify hematoma volume and assess for expansion

›Vascular assessment

›Doppler of radial and ulnar arteries

›Brachial artery injury or thrombosis

›Low resistance waveforms suggest arterial injury

›Deep vein thrombosis exclusion

›Non-compressible antecubital or axillary vein

›Limitations for ACS

›Not diagnostic for ACS itself

›Cannot reliably measure compartment pressure

›Supplementary to clinical exam and ICP measurement

07Disposition/dispo28

Admission criteria

›All confirmed or strongly suspected ACS requires admission

›Emergent surgical consultation immediately upon diagnosis

›American College of Surgeons guideline: do not delay fasciotomy for imaging

›Target operative fasciotomy within 8 hours of onset

›Operating room as destination — not observation ward

›Volar fasciotomy approach via curvilinear incision

›Separate dorsal incision if dorsal pressures elevated after volar release

›Carpal tunnel release if hand involvement

ICU-level care indications

›ICU admission criteria

›Rhabdomyolysis with acute kidney injury

›Creatinine rising, oliguria, or anuria

›Active myoglobinuria requiring aggressive fluid management

›Hyperkalemia with ECG changes

›Peaked T-waves, QRS widening, sine wave pattern

›Requires cardiac monitoring and immediate treatment

›Metabolic acidosis — pH <7.2 or lactate >4 mmol/L

›Hemodynamic instability

High-risk observation

›Serial neurovascular check protocol

›High-risk patients: forearm fractures, crush injuries, vascular injuries, "found down"

›Serial exams every 1–2 hours for 24–48 hours

›Serial ICP measurements if any clinical change

›Never discharge a high-risk patient without adequate observation period

Transfer criteria

›Indications for transfer to higher level of care

›Facility without orthopedic or hand surgery coverage

08Treatment/t73

Immediate non-surgical measures

›Cast and dressing management

›Remove all circumferential dressings, casts, and splints immediately

›American College of Surgeons Best Practices recommendation

›Bivalving a cast can reduce compartment pressure by up to 65%

›Cutting dressing padding to skin provides further relief

›Do not reapply circular bandaging after removal

›Limb positioning

›Position at heart level

›Avoid elevation — reduces arterial perfusion pressure

›Avoid dependency — increases venous pressure and edema

Analgesia

›Pain management strategy

›Opioid analgesics — primary agent for acute pain control

›Titrate carefully — escalating requirements are a diagnostic signal

›Morphine IV 0.1 mg/kg every 4 hours PRN

›Hydromorphone IV 0.015 mg/kg every 3–4 hours as alternative

›Avoid regional nerve blocks

›May mask pain progression and delay diagnosis of ACS

›American College of Surgeons guideline: avoid in high-risk patients

›NSAIDs as sole analgesic — avoid

›May mask pain trajectory without adequate coverage

›Acetaminophen as adjunct

›975 mg IV every 6 hours or 1000 mg PO every 6 hours

Rhabdomyolysis management

›IV fluid resuscitation for rhabdomyolysis

›Normal saline (0.9%) or lactated Ringer's — first-line crystalloid

›Avoid lactated Ringer's if severe hyperkalemia

›Initial bolus 1–2 L over 30–60 minutes

›Maintenance rate 200–300 mL/hr

›Urine output target

›200–300 mL/hr with active myoglobinuria

›Reduces myoglobin-induced tubular necrosis

›Urinary alkalinization with sodium bicarbonate

›50–100 mEq NaHCO3 in 1 L D5W at 100–200 mL/hr

›Target urine pH >6.5

›May reduce myoglobin precipitation in tubules (evidence limited)

›Mannitol — consider for severe myoglobinuria

›0.5–1 g/kg IV over 30 minutes

›Osmotic diuresis and free-radical scavenging

›Avoid if oliguria or volume-depleted

Hyperkalemia management

›Life-threatening hyperkalemia protocol

›Calcium gluconate 10% — membrane stabilization

›1–3 g (10–30 mL of 10% solution) IV over 2–10 minutes

›Onset: 1–3 minutes; duration 30–60 minutes

›Repeat every 5–10 minutes if ECG changes persist

›Insulin plus dextrose — intracellular potassium shift

›Regular insulin 10 units IV with dextrose 50% 50 mL (25 g)

›Onset: 15–30 minutes; monitor glucose every 30 minutes

›Sodium bicarbonate — intracellular shift

›50–100 mEq IV over 5 minutes

›Most effective with concurrent metabolic acidosis

›Salbutamol (albuterol) nebulized — adjunct

›10–20 mg nebulized (high dose)

›Onset 30 minutes; shifts K+ intracellularly

›Kayexalate (sodium polystyrene sulfonate) — for elimination

›15–30 g PO or rectally

›Slow onset (hours) — not for acute emergencies

›Hemodialysis — for refractory hyperkalemia with renal failure

Definitive surgical treatment

›Emergent fasciotomy — only definitive treatment

›Timing

›Optimal: within 8 hours of onset

›Fasciotomy >8–24 hours: controversial — necrosis may have occurred

›Delayed fasciotomy may not improve outcomes and risks infection from necrotic tissue

›Surgical technique

›Volar approach: curvilinear incision decompresses volar compartment

›May reduce dorsal pressures indirectly

›If dorsal ICP remains elevated: separate dorsal incision required

›Carpal tunnel release included if hand compartment involved

›Long, generous skin and fascial incisions releasing all compartments

›All incisions left open after fasciotomy

›Wound management

›Fasciotomy wounds left open — not closed primarily

›Delayed primary closure or split-thickness skin graft at 48–72 hours

›Skin grafting required in approximately 61% of forearm fasciotomy cases

›Second-look surgery at 48 hours: debridement of nonviable muscle

09Special Populations/sp69

Pregnancy

›Physiologic considerations in pregnancy

›Increased intravascular volume and reduced oncotic pressure

›Higher baseline forearm edema risk

›Lower threshold for compartment pressure rise with injury

›Positioning modifications

›Left lateral tilt for gravid uterus during transport and care

›Avoid prolonged supine positioning (aortocaval compression)

›Diagnostic and treatment modifications

›ICP measurement thresholds unchanged

›ΔP <30 mmHg remains fasciotomy threshold

›Fluid resuscitation

›Crystalloid preferred — goal urine output 200–300 mL/hr

›Monitor for pulmonary edema with large volume resuscitation

›Medication safety

›Avoid NSAIDs after 20 weeks gestation

›Mannitol — category C; use only if benefit outweighs risk

›Opioids: fetal monitoring required with IV opioid use

›Fasciotomy under general or regional anesthesia

›Avoid regional blocks that mask pain if diagnosis still evolving

›Fetal heart monitoring during and after procedure

›Obstetric consultation required for any significant trauma in pregnancy

Geriatric

›Physiologic modifications in elderly patients

›Reduced diastolic blood pressure

›Lower ΔP threshold may be reached at lower absolute ICP

›Heightened vigilance required — may reach fasciotomy threshold faster

›Decreased pain perception and reporting

›Underreporting of pain out of proportion

›Cognitive impairment may mask classic symptoms

›Polypharmacy and anticoagulation

›High prevalence of warfarin, DOAC, antiplatelet therapy

›Reversal consideration before fasciotomy

›Treatment modifications

›Fluid resuscitation — caution with volume overload

›Monitor for pulmonary edema — cardiac reserve limited

›Titrate IV fluids to urine output rather than fixed rates

›Analgesia dose reduction

›Opioid sensitivity increased — reduce starting dose by 25–50%

›Renal and hepatic metabolism impaired — extend dosing intervals

›Rhabdomyolysis complications more severe

›Acute kidney injury more likely — creatinine baseline often elevated

›Earlier nephrology involvement

›Wound healing delayed

›Anticipate longer post-fasciotomy recovery

›Higher rate of skin graft complications

Pediatrics

›Unique diagnostic challenges in children

›Classic 5 P's often absent or unreliable

›Use the 3 A's: anxiety, agitation, increasing analgesic requirements

›Children may be unable to verbalize pain out of proportion

›Gottlieb et al., 2019: high index of suspicion mandatory

›Supracondylar humerus fractures — most common pediatric mechanism

›Forearm both-bone fractures also high risk

›High-energy trauma or falls from height

›ICP measurement thresholds in children

›ΔP <30 mmHg threshold applicable to children

›Absolute ICP >30 mmHg should prompt fasciotomy consideration

›Normal resting compartment pressure may be slightly lower in children

›Treatment modifications in pediatrics

›Analgesia weight-based dosing

›Morphine 0.05–0.1 mg/kg IV every 3–4 hours

›Acetaminophen 15 mg/kg PO/IV every 6 hours (max 75 mg/kg/day)

›Avoid regional nerve blocks if diagnosis still evolving

›Fluid resuscitation for rhabdomyolysis

›Normal saline: 20 mL/kg bolus then titrate to urine output 3–5 mL/kg/hr

›Monitor closely for fluid overload — higher risk in small children

›Fasciotomy in children

›Same principles: emergent when ΔP <30 mmHg

›Outcomes generally favorable with early surgical intervention

›Growth plate considerations for fracture fixation at same procedure

›Pediatric surgical consultation mandatory

10Background/b70

Epidemiology

›Incidence and demographics

›Overall ACS incidence

›Total extremity ACS: 7.3 per 100,000 per year in males

›Total extremity ACS: 0.7 per 100,000 per year in females

›Male predominance due to higher trauma rate

›Forearm-specific epidemiology

›Forearm is the most common upper extremity site for ACS

›Second most common site overall after the leg

›35% of forearm ACS cases linked to fractures (systematic review)

›10% linked to narcotic overdose/"found down"

›8% linked to IV infiltration/extravasation

›Complications

›Occur in approximately one-third of patients

›Strongly associated with delays in fasciotomy beyond 6 hours

›Neurological deficit most common complication post-fasciotomy (21%)

›Skin grafting required in approximately 61% of forearm fasciotomy cases

Pathophysiology

›Compartment anatomy

›Three forearm compartments

›Volar compartment: flexor muscles, median and ulnar nerves, radial and ulnar arteries

›Dorsal compartment: extensor muscles, posterior interosseous nerve

›Mobile wad: brachioradialis, ECRL, ECRB

›Compartment boundaries

›Rigid osseofascial walls limit expansion

›Intracompartmental pressure rise with any volume increase

›Pressure-ischemia cascade

›Volume increase from edema, hemorrhage, or external compression

›Pressure rises within non-expandable fascial compartment

›Venous pressure exceeded → venous obstruction

›Perfusion gradient (ΔP) falls below critical threshold of 30 mmHg

›Arteriolar flow insufficient despite palpable distal pulses

›Ischemic injury timeline

›Irreversible muscle damage: begins at 4–6 hours of ischemia

›Nerve ischemia: detectable within 30 minutes; irreversible at 4–8 hours

›Complications strongly associated with fasciotomy delays beyond 6 hours

›Rhabdomyolysis pathway

›Muscle necrosis releases myoglobin, potassium, phosphate, purines

›Myoglobin precipitates in renal tubules — acute tubular necrosis

›Hyperkalemia — potentially fatal arrhythmias

›Metabolic acidosis from lactate and potassium release

›Reperfusion after fasciotomy may transiently worsen hyperkalemia and acidosis

›Late complications

›Volkmann ischemic contracture

›Muscle fibrosis from prolonged ischemia

›Decreased hand and wrist motion, diminished strength, finger clawing

›Nerve lesions common in severe cases (Ozer K, 2020)

Therapeutic Considerations

›Fasciotomy timing evidence

›Timing outcomes data

›Fasciotomy <6 hours: generally favorable outcomes

›Fasciotomy at 6–12 hours: intermediate outcomes; complications increased

›Fasciotomy >12 hours: substantially higher complication rate

›Fasciotomy >24 hours after onset: risk of infection from necrotic tissue release

›Delayed fasciotomy controversy

›When necrosis is established, fasciotomy may not restore function

›Releases potentially toxic necrotic material systemically

›Decision requires experienced surgical judgment

›Pressure measurement threshold evidence

›Delta-P threshold (ΔP <30 mmHg)

›More physiologically sound than absolute ICP threshold

›Accounts for patient's own perfusion pressure

›Supported by American College of Surgeons Best Practices

›Continuous vs single measurement

›Continuous monitoring captures dynamic pressure fluctuations

›Single measurements may miss transient peaks

›Rhabdomyolysis evidence

›High risk of AKI after traumatic limb compartment syndrome (Tsai et al., 2015)

›Aggressive fluid resuscitation reduces incidence of dialysis-requiring AKI

›Urine alkalinization: evidence limited but widely practiced

›CK as prognostic marker

›CK >669 U/L associated with ACS in forearm fracture cohort

›Serial CK guides fluid resuscitation intensity

11Patient Discharge Instructions/pdi29

copy discharge instructions

›Discharge instructions for Compartment Syndrome (Forearm)

›You were treated for compartment syndrome of the forearm — a serious condition where pressure builds up in the muscle compartments causing damage to muscles and nerves.

›Surgery (fasciotomy) was performed to release the pressure and protect your muscles and nerves.

›Your wounds may be left open temporarily and will require additional surgery for closure.

›Wound care instructions

›Keep dressings clean and dry as instructed by your surgical team.

›Do not remove or change wound dressings without specific instruction from your surgeon.

›You will have a follow-up surgery in 2–3 days for wound assessment and possible skin grafting.

›Activity restrictions

›Keep the affected arm at heart level — do not hang it down or raise it above your head for extended periods.

›No heavy lifting with the affected arm until cleared by your surgeon.

›Avoid any activities that increase forearm pain or swelling.

›Medications

›Take prescribed pain medications as directed — do not delay doses if pain is returning.

›Take all antibiotics (if prescribed) for the full course.

›Do not take NSAIDs (ibuprofen, naproxen) without your doctor's approval.

›Return to Emergency Department immediately for

›Worsening pain in the forearm despite pain medication

›New or worsening numbness or tingling in your hand or fingers

›Inability to move your fingers

›Worsening swelling or tightness of the forearm

›Dark, tea-colored, or cola-colored urine

›Fever above 38.5°C (101.3°F)

›Signs of wound infection: increasing redness, warmth, discharge, or odor at surgical site

›Chest pain or irregular heartbeat

›Follow-up instructions

›Return to hospital in 48–72 hours for scheduled wound assessment and possible closure.

12References/r29

Guidelines and key sources

›Primary evidence base

›von Keudell AG, Weaver MJ, Appleton PT, et al. Diagnosis and Treatment of Acute Extremity Compartment Syndrome. Lancet. 2015. PMID 26460664

›Comprehensive review of ACS pathophysiology, diagnosis, and management

›Basis for ΔP <30 mmHg fasciotomy threshold

›Shaikh AF, Blazar PE, Earp BE, Zhang D. Acute Compartment Syndrome of the Upper Extremity. Journal of Hand Surgery. 2026. PMID 40853300

›CK >669 U/L and neutrophil count >7.01/L as ACS predictors in forearm fractures

›Low albumin identified as independent risk factor

›Long B, Koyfman A, Gottlieb M. Evaluation and Management of Acute Compartment Syndrome in the Emergency Department. Journal of Emergency Medicine. 2019. PMID 30685220

›Emergency medicine focused review of diagnosis and management

›Kalyani BS, Fisher BE, Roberts CS, Giannoudis PV. Compartment Syndrome of the Forearm: A Systematic Review. Journal of Hand Surgery. 2011. PMID 21371630

›Epidemiology: 35% fractures, 10% narcotic overdose, 8% IV infiltration

›Duckworth AD, Mitchell SE, Molyneux SG, et al. Acute Compartment Syndrome of the Forearm. Journal of Bone and Joint Surgery. 2012. PMID 22617929

›Mortensen SJ, Vora MM, Mohamadi A, et al. Diagnostic Modalities for Acute Compartment Syndrome: A Systematic Review. JAMA Surgery. 2019

›Gottlieb M, Adams S, Landas T. Evaluation and Management of ACS in Pediatric Patients. Pediatric Emergency Care. 2019. PMID 31157749

›Fernandez JJ, Smith SR. Traumatic Rhabdomyolysis: Crush Syndrome, Compartment Syndrome, and the Found Down Patient. JAAOS. 2024. PMID 38109720

›Tsai WH, Huang ST, Liu WC, et al. High Risk of Rhabdomyolysis and AKI After Traumatic Limb Compartment Syndrome. Annals of Plastic Surgery. 2015. PMID 25785380

›Turkula SC, Fuller DA. Extensile Fasciotomy for Compartment Syndrome of the Forearm and Hand. Journal of Orthopaedic Trauma. 2017. PMID 28697090

›Yang S, Wang T, Long Y, et al. Both-Bone Forearm Fractures and ACS: Predisposing Factors. Injury. 2023. PMID 37394329

Societal guidelines

›Society-level recommendations

›American College of Surgeons Best Practices in Orthopaedic Trauma. Davis ML et al. 2015

›Remove all circumferential dressings immediately

›ΔP <30 mmHg as fasciotomy threshold

›Avoid regional anesthesia in high-risk patients

›American College of Surgeons Best Practices for Acute Pain Management in Trauma. Bernard A et al. 2020

›Opioid titration with clinical monitoring for escalating requirements

›Caution with regional blocks masking compartment syndrome diagnosis

Evidence & Review

Evidence & Review