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A 14-year old boy involved in an auto vs. e-bike accident was transferred from a non-trauma center ED to your ED. At the outside ED he was found to have a negative head and c-spine CT, normal CXR, small liver laceration, stable hemoglobins, and a comminuted right tibia and fibula fracture, which was splinted. On arrival he is complaining loudly of the pain in his leg. You open the splint to re-evaluate his leg and find that he has firmness to his anterior tibial compartment and worsened pain with passive plantarflexion. Skin color and sensation are normal. You measure the compartment pressure.
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October 8, 2025 at 8:08 pm
E) Delta pressure = diastolic BP – compartment pressure is < 30 mm Hg
Normal compartment pressures are 0-8 mm Hg. Pain develops when pressures reach 20-30 mm Hg. Capillary blood flow perfusion being compromised is more important and occurs when compartment pressures approach mean arterial pressure. Generally, a delta pressure (diastolic BP – compartment pressure measured) of < 20-30 mm Hg is considered diagnostic of compartment syndrome potentially warranting fasciotomy. Compartment syndrome is most commonly precipitated by fractures. Signs include pain out of proportion to apparent injury, paresthesias and decreased sensation, pain with passive stretching of the compartment muscles, tense or firm compartment to palpation, weakness of the affected compartment’s muscles, and pallor and paralysis (late findings). It is important to reassess patients with extremity fractures who are having worsening pain.