USMLE Prep - Medical Reference Library

Limb Compartment Syndrome — Diagnosis and Fasciotomy

System: Orthopedics • Reviewed: Aug 31, 2025 • Step 1Step 2Step 3

Synopsis:

Severe pain out of proportion, pain with passive stretch, and tense compartments suggest the diagnosis; obtain pressures when unclear and arrange urgent fasciotomy.

Key Points

  • Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
  • Use system-specific risk tools to guide testing and disposition.
  • Order high-yield tests first; escalate imaging when indicated.
  • Start evidence-based initial therapy and reassess frequently.

Algorithm

  1. Primary survey and vitals; IV access and monitors.
  2. Focused history/physical; identify red flags and likely etiologies.
  3. Order system-appropriate labs and imaging (see Investigations).
  4. Initiate guideline-based empiric therapy (see Pharmacology).
  5. Reassess response; arrange consultation and definitive management.

Clinical Synopsis & Reasoning

For Limb Compartment Syndrome Emergency Fasciotomy, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CBC (Baseline hematology), BMP (Electrolytes/renal). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.


Treatment Strategy & Disposition

Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Analgesia/Antipyretics. Use validated frameworks (e.g., Do and Do Not) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.


Epidemiology / Risk Factors

  • Risk factors vary by condition and patient profile

Investigations

TestRole / RationaleTypical FindingsNotes
CBCBaseline hematologyAbnormal counts
BMPElectrolytes/renalDerangements

Do and Do Not

ActionComment
Analgesia and urgent consultParallel steps
Ice and hypotensionAvoid worsening perfusion
Delay for imagingDo not delay when diagnosis is clear

Pharmacology

MedicationMechanismOnsetRole in TherapyLimitations
AnalgesiaPain controlMinutesAdjunct—; ED use

Prognosis / Complications

  • Prognosis depends on severity, comorbidities, and timeliness of care

Patient Education / Counseling

  • Explain red flags and when to seek emergent care.
  • Reinforce medication adherence and follow-up plan.

Notes

Keep a low threshold in children and anticoagulated patients. Document serial neurovascular exams.


References

  1. Orthopedic Trauma Association — Compartment Syndrome — Link
  2. AAOS Emergency Care Resources — Link