In this MRCS Part B scenario a patient, John Smith, is brought into A&E having sustained a comminuted fracture of his right tibia/fibula after a stone wall fell on top of his leg. He is complaining of severe pain in his calf.

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Key Information

Compartment syndrome should be suspected with worsening pain out of proportion to the injury, particularly of passive stretching of the affected compartment, pain not responding to analgesia.

The 6 Ps of compartment syndrome should be remembered as pain, pain, pain, pain, pain, pain: by the time the later signs develop, there is already significant muscle death and nerve damage.

Paraesthesia and loss of distal pulses would be late signs of compartment syndrome and one must have a high index of suspicion for this devestating sequel of tibal fractures.

Open fractures, despite having potential injuries to the fascia, have just as much potential to develop compartment syndrome

Rhabdomyolysis is the release of potentially toxic muscle cell components into the systemic circulation. It can be triggered by trauma such as a fracture or lengthy compression of muscles. Other causes include massive burns, hypothermia, hyperthermia and acute ischemia with a reperfusion injury.