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
Patient Discharge Instructions
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.
Long-term hand surgery and physiotherapy follow-up will be arranged for rehabilitation.
Recovery may require weeks to months depending on extent of injury.
References
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
Walters TJ, Kottke MA, Hargens AR, Ryan KL. Noninvasive Diagnostics for Extremity Compartment Syndrome. Journal of Trauma and Acute Care Surgery. 2019. PMID 31246908
State-of-the-art review of NIRS and emerging noninvasive modalities
Bouklouch Y, Miclau T, Harvey E. Diagnosis of Acute Compartment Syndrome: Current Diagnostic Parameters. Injury. 2025. PMID 41173558
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.