Compartment Syndrome Timing After Trauma
Compartment syndrome typically develops within the first 24 hours after trauma, but can occur up to 65 hours (approximately 2.7 days) post-injury, requiring vigilant clinical monitoring throughout this extended period. 1, 2
Critical Time Windows
Peak Risk Period
- Most cases occur within the first 24 hours, with intensive monitoring recommended every 30 minutes to 1 hour during this critical window 1
- The highest risk is in the immediate post-trauma period, particularly with high-energy mechanisms 2
Extended Risk Window
- Compartment syndrome can develop up to 65 hours after the initial trauma, necessitating continued surveillance beyond the first day 2
- There is a tendency for earlier onset (mean 16.9 hours) after high-energy trauma compared to low-energy mechanisms (mean 28 hours) 2
- Clinical monitoring remains fundamental throughout this extended period to enable prompt surgical intervention 2
Risk Factors Requiring Extended Surveillance
The following injuries carry increased risk and warrant prolonged monitoring 1:
- Fractures (particularly tibial fractures)
- Crush injuries
- Hemorrhagic injuries
- Reperfusion of ischemic lesions
- Hypotension
Monitoring Strategy
First 24 Hours
- Repetitive clinical assessment every 30 minutes to 1 hour in patients with risk factors 1
- Evaluate for the "four P's": pain (especially with passive stretch), paraesthesia, paresis, and pressure/tension 1
- Measure compartment pressure if clinical suspicion exists (>30 mmHg or differential pressure <30 mmHg) 1
Beyond 24 Hours
- Continue clinical monitoring up to 65 hours post-trauma, as delayed presentations can occur 2
- Maintain heightened alertness even after the initial 24-hour period, particularly in high-risk injuries 2
Critical Pitfalls
Do not rely on late signs such as pulselessness and pallor—these indicate irreversible damage and are too late for meaningful intervention 1. The diagnosis must be made clinically before these findings appear, as irreversible nerve and muscle necrosis can occur within 6 hours of elevated compartment pressure 3.
Sedated or obtunded patients present particular diagnostic challenges, as pain assessment is unreliable; in these cases, compartment pressure monitoring becomes more critical 1.