Question:
A 25-year-old male presents after a motorbike accident with a closed midshaft tibial fracture. Six hours later, he complains of severe pain disproportionate to the injury, worsened by passive dorsiflexion. Distal pulses are palpable, but there is loss of sensation in the first web space. What is the most appropriate next step in management?
A 25-year-old male presents after a motorbike accident with a closed midshaft tibial fracture. Six hours later, he complains of severe pain disproportionate to the injury, worsened by passive dorsiflexion. Distal pulses are palpable, but there is loss of sensation in the first web space. What is the most appropriate next step in management?
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Pain out of proportion after fracture with pain on passive stretch = compartment syndrome; treatment is immediate fasciotomy.
Updated On: May 14, 2026
- Elevate the limb and observe
- Immediate fasciotomy
- Administer opioid analgesics
- Apply a cast and schedule follow-up
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The Correct Option is B
Solution and Explanation
Concept:
Acute compartment syndrome is a surgical emergency. It commonly occurs after tibial fractures. Severe pain out of proportion and pain on passive stretch are early and important signs.
Step 1: Identify the warning symptoms.
The patient has: \[ \text{Severe pain out of proportion + pain on passive dorsiflexion} \] These are classic signs of compartment syndrome.
Step 2: Understand pulse finding.
Palpable distal pulses do not rule out compartment syndrome because vascular compromise is a late feature.
Step 3: Choose urgent treatment.
The definitive treatment is: \[ \text{Immediate fasciotomy} \] Therefore, the correct answer is Immediate fasciotomy.
Step 1: Identify the warning symptoms.
The patient has: \[ \text{Severe pain out of proportion + pain on passive dorsiflexion} \] These are classic signs of compartment syndrome.
Step 2: Understand pulse finding.
Palpable distal pulses do not rule out compartment syndrome because vascular compromise is a late feature.
Step 3: Choose urgent treatment.
The definitive treatment is: \[ \text{Immediate fasciotomy} \] Therefore, the correct answer is Immediate fasciotomy.
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