The 'silent' compartment syndrome

Injury. 2009 Feb;40(2):220-2. doi: 10.1016/j.injury.2008.07.023. Epub 2009 Feb 8.


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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Compartment Syndromes / diagnosis*
  • Compartment Syndromes / etiology
  • Early Diagnosis
  • Femoral Fractures / surgery*
  • Humans
  • Male
  • Middle Aged
  • Pain, Intractable / etiology
  • Postoperative Complications / diagnosis*
  • Tibial Fractures / surgery*
  • Young Adult