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Acute compartment syndrome — MCCQE Part 1 MCQ

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ModerateTraumaAcute compartment syndromeMCCQE Part 1

A 28-year-old man has increasing forearm pain after a both-bone forearm fracture. Pain is severe with passive finger extension and the forearm is tense; pulses are still present. Which of the following is the most appropriate next step?

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Correct answer: B — Urgent fasciotomy assessment by orthopaedic surgery

Pain out of proportion and pain with passive stretch indicate compartment syndrome, which is a surgical emergency. Pulses can remain present until late, so their presence does not exclude the diagnosis. Tight casts and delayed treatment increase the risk of muscle necrosis and Volkmann contracture.

Reference: Canadian Orthopaedic Association trauma practice; ATLS principles