The 'silent' compartment syndrome

Intractable pain out of proportion to the injury sustained is considered tube the earliest and most reliable indicator of a developing compartment syndrome. We report 4 cases where competent sensate patient's developed compartment syndromes without any significant pain. The first patient developed a painless compartment syndrome in the well leg following surgery for femoral fracture Oil the other side. The second patient developed the silent compartment syndrome post-operatively following a tibial nailing for a tibial The third patient presented with the painless compartment syndrome following a tibial plateau fracture. Our prevailing culture of a high-index of clinical suspicion and surveillance prompted us to perform compartment pressure measurements. The surgical findings at immediate fasciotomy confirmed the diagnoses. Our experience indicates that pain is not a reliable clinical indicator for underlying compartment syndrome, so in a competent sensate patient the absence of pain does not exclude compartment syndrome. We believe that a high index of clinical Suspicion Must prevail in association with either continuous compartment pressure monitoring or frequent repeated documented clinical examination with a low threshold for pressure measurement. (C) 2008 Elsevier Ltd. All rights reserved.