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Compartment syndrome — MCCQE Part 1 MCQ

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HardFracturesCompartment syndromeMCCQE Part 1

23-year-old man after tibial fracture presents with increasing severe leg pain despite opioids. Pain is worsened by passive toe stretch and pulses are present. Which of the following is the most appropriate next step?

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Correct answer: E — Urgently involve orthopaedics for fasciotomy consideration

Urgently involve orthopaedics for fasciotomy consideration is best because pain out of proportion and pain on passive stretch suggest compartment syndrome. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Normal pulses do not exclude compartment syndrome.

Reference: Canadian Orthopaedic Association guidance