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Acute compartment syndrome — MCCQE Part 1 MCQ

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HardFracturesAcute compartment syndromeMCCQE Part 1

A 28-year-old man is 8 hours post intramedullary nailing for a tibial fracture. He reports escalating leg pain despite opioids, with pain on passive toe extension and a tense anterior compartment. Dorsalis pedis pulse is present. What is the most appropriate next step in management?

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Correct answer: D — Urgent surgical fasciotomy

Severe pain out of proportion and pain with passive stretch after tibial fracture indicate compartment syndrome, requiring urgent fasciotomy. Distal pulses can remain present until late and should not reassure. Waiting for sensory loss risks irreversible muscle and nerve injury.

Reference: Canadian Orthopaedic Association resources; MCC Objectives—Fractures