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Acute compartment syndrome after tibial fracture — RCPSC EM MCQ

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HardMusculoskeletalAcute compartment syndrome after tibial fractureRCPSC EM

A patient has acute bilateral sciatica, saddle sensory loss and new painless urinary retention. Post-void residual is 140 mL and lower-limb power is normal. What is the next ED step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Arrange urgent MRI and surgical consultation for suspected cauda equina syndrome

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

B is correct because saddle sensory loss and bladder dysfunction warrant urgent MRI and spinal consultation; a residual below 200 mL does not safely exclude cauda equina syndrome. C treats a screening threshold as a rule-out test. D and E delay diagnosis. A does not evaluate the compressive emergency.

Reference: Emergency Care BC, Cauda Equina and Conus Medullaris Syndromes: https://emergencycarebc.ca/clinical_resource/clinical-summary/cauda-equina-and-conus-medullaris-syndromes/