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Scaphoid fracture — RCPSC EM MCQ

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HardMusculoskeletalScaphoid fractureRCPSC EM

After tibial fracture splinting, a patient has escalating pain despite opioids, pain on passive toe extension and a tense calf. Dorsalis pedis pulse remains palpable. What is the most appropriate next step?

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Correct answer: C — Split or remove constriction and obtain immediate surgical assessment

The best answer is “Split or remove constriction and obtain immediate surgical assessment”. Acute compartment syndrome is a clinical limb-threatening emergency; pulses may remain present until late. Immediately release external constriction, keep the limb at heart level and obtain urgent surgical assessment for fasciotomy. Prolonged elevation, imaging-first evaluation, added padding or analgesia alone delays restoration of tissue perfusion.

Reference: Emergency Care BC: Acute Compartment Syndrome: https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-compartment-syndrome/