Who should I consult for acute compartment syndrome?

Immediate Surgical Consultation for Acute Compartment Syndrome

Consult orthopedic surgery immediately for suspected acute compartment syndrome, as this is a time-sensitive surgical emergency requiring emergent fasciotomy to prevent limb loss, permanent disability, and death. 1

Primary Consultation

• Orthopedic surgery is the primary specialty to consult for acute compartment syndrome of the limbs, as they perform the definitive treatment—emergent fasciotomy 1
• The consultation should be urgent and immediate upon clinical suspicion, as delays beyond 6-8 hours significantly increase the risk of irreversible muscle and nerve damage 1, 2
• Do not wait for confirmatory testing to initiate surgical consultation if clinical suspicion is high, as the benefits of fasciotomy decrease considerably the later it is performed 1

Additional Consultations Based on Clinical Context

Vascular Surgery

• Consult vascular surgery if there is concurrent vascular injury, as this dramatically increases compartment syndrome risk and may require revascularization procedures 3
• Vascular injury combined with fractures creates a particularly high-risk scenario requiring intensive monitoring and potentially prophylactic fasciotomy 3

Nephrology/Critical Care

• Consider nephrology consultation for patients developing rhabdomyolysis from compartment syndrome, particularly if crush injury is involved, as they may require urgent dialysis for hyperkalemia and acute kidney injury 1
• Intermittent hemodialysis is the preferred modality for rapid potassium clearance in crush-induced acute kidney injury 1

Critical Time-Sensitive Actions Before Surgical Consultation

While awaiting surgical evaluation, initiate these immediate interventions:

• Remove all constricting dressings, casts, or bandages immediately 1
• Position the limb at heart level—avoid elevation as this reduces blood flow and worsens perfusion 1, 3
• Optimize tissue perfusion by avoiding hypotension and maintaining adequate blood pressure 2
• Measure compartment pressures if diagnosis is uncertain: fasciotomy is indicated when pressures are ≥20 mmHg in hypotensive patients, ≥30 mmHg in unconscious/uncooperative patients, or ≥30 mmHg in normotensive patients with positive clinical findings 1

Common Pitfalls to Avoid

• Do not delay consultation waiting for late signs (pulselessness, pallor, paralysis)—these indicate arterial occlusion and irreversible damage has likely occurred 1
• Do not rely solely on clinical examination in obtunded, confused, or pediatric patients where signs may be impossible to elicit—proceed directly to compartment pressure measurement and surgical consultation 1, 4
• Do not elevate the affected limb above heart level, as this common mistake further compromises perfusion 3, 2
• Do not wait for pulse loss—this is a late finding indicating the diagnosis was missed 1, 5

High-Risk Scenarios Requiring Heightened Vigilance

• Tibial shaft fractures (highest risk, 4-5% develop compartment syndrome) 3
• Young males under 35 years with fractures (10-13 times higher incidence) 3, 6
• Vascular injury with fracture (requires monitoring every 30-60 minutes for first 24 hours) 3
• Patients on anticoagulation (substantially elevated bleeding risk into compartments) 3, 6