title: The 'silent' compartment syndrome.
abstract: Intractable pain out of proportion to the injury sustained is considered to be the earliest and most reliable indicator of a developing compartment syndrome. We report 4 cases where competent sensate patients developed compartment syndromes without any significant pain. The first patient developed a painless compartment syndrome in the well leg following surgery for femoral fracture on the other side. The second patient developed the silent compartment syndrome post-operatively following a tibial nailing for a tibial fracture. 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.
authors.affiliation: Department of Trauma and Orthopaedics, Derbyshire Royal Infirmary, Derby Road Derby, Derby, Derbyshire DE1 2QY, United Kingdom. sachin.badhe@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Badhe
authors.forename: D
authors.initials: D
authors.lastname: Baiju
authors.forename: R
authors.initials: R
authors.lastname: Elliot
authors.forename: J
authors.initials: J
authors.lastname: Rowles
authors.forename: D
authors.initials: D
authors.lastname: Calthorpe
mesh_terms: D000293:Adolescent; D000328:Adult; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000209:etiology; D042241:Early Diagnosis; D005264:Femoral Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis*; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult