Acute Compartment Syndrome: Timeline, Diagnosis, and Emergency Treatment

Acute compartment syndrome (ACS) is a surgical emergency. Pressure within a closed fascial compartment exceeds capillary perfusion pressure → ischemia → necrosis.

Timeline (Tibia Example)

• 0–6 hours: Rising pressure; pain out of proportion, paresthesia, pain on passive stretch. Perfusion marginal.
• 6–8 hours: Critical ischemia; established neurologic deficit (numbness, weakness); tense compartment.
• >8–12 hours: Irreversible muscle/nerve necrosis; contractures (Volkmann’s), renal failure (rhabdomyolysis), amputation risk.

Diagnosis

• Clinical: Pain (especially passive stretch), paresthesia, pallor, pulselessness (late), pressure (tightness).
• Intracompartmental pressure (ICP) monitoring: ΔP (diastolic BP – ICP) < 30 mmHg → fasciotomy.

Treatment

Emergency fasciotomy (full compartment release). Delay >6–8 hours → permanent disability.

Chronic exertional compartment syndrome (CECS) is distinct: reversible, exercise‑induced, managed conservatively or electively.