What is compartment syndrome?
The body's muscles are enclosed in tight fibrous compartments called fasciae. When bleeding, swelling, or oedema occurs within a compartment — following fracture, crush injury, prolonged compression, surgery, or reperfusion — pressure rises. Once it exceeds capillary perfusion pressure, blood cannot reach the muscle and nerves.
Without fasciotomy within approximately 6 hours of onset of ischaemia, permanent muscle and nerve damage occurs. After 12 hours, damage is likely to be catastrophic.
Acute compartment syndrome most commonly affects:
- The leg (following tibial fracture — the most common site)
- The forearm (following distal radius fracture or elbow surgery)
- The foot and hand in some circumstances
- The thigh (following femoral fracture or surgery)
- The gluteal compartment (following prolonged position during surgery)
Clinical signs that should trigger urgent assessment
The "5 Ps" of compartment syndrome are a classic teaching aide:
- Pain — severe, out of proportion to the injury, worsened by passive stretch
- Pressure — a tense, wooden feel to the compartment
- Paraesthesia — numbness, tingling, or burning in the nerves passing through the compartment
- Paresis — weakness of muscles within the compartment
- Pallor / Pulselessness — late signs, indicating severe ischaemia
The most important early sign is pain out of proportion to the injury and pain on passive stretch. Waiting for all 5 Ps is likely to result in delayed diagnosis. Compartment pressure measurement provides objective confirmation; a delta P within 30 mmHg of diastolic blood pressure is widely accepted as requiring fasciotomy.
Common scenarios in compartment syndrome negligence claims
Tight plaster cast not recognised
A patient with a forearm or leg fracture is placed in a plaster cast. They complain of increasing pain and the cast is not split. Compartment syndrome develops.
A&E discharge after fracture
A patient with a tibial or forearm fracture is assessed in A&E and discharged. Discharge instructions do not adequately flag signs of compartment syndrome. By the time the patient returns, irreversible damage has occurred.
Post-surgical compartment syndrome
Compartment syndrome following tibial nail insertion, knee or ankle surgery, or vascular procedures requiring limb reperfusion. Post-operative nursing observations are the primary mechanism for identification. Failure to monitor and escalate is a common allegation.
Intravenous infiltration in paediatric patients
Compartment syndrome in children can be caused by extravasation of intravenous fluid or medication. Recognition and prompt treatment are essential.
Harm from delayed diagnosis
- Volkmann's ischaemic contracture — permanent contracture of the forearm muscles causing clawing of the hand
- Foot drop — permanent peroneal nerve damage
- Chronic pain syndrome
- Muscle necrosis requiring debridement or amputation
- Limb amputation in the most severe cases
Frequently asked questions
Can I claim if a tight plaster cast caused compartment syndrome?
Yes — if the clinical signs were present and the cast was not split in time, and the delay fell below the required standard of care.
What if I was discharged from A&E and then developed compartment syndrome at home?
If the discharge instructions were inadequate, or if compartment syndrome was developing at the time of discharge and should have been identified, a claim may be available.
Is compartment syndrome always negligence?
No. Compartment syndrome can develop rapidly and may progress despite appropriate monitoring. The question is whether the clinical signs were present and not acted upon within an appropriate timeframe.
Related guides
- Orthopaedic negligence claims
- A&E negligence claims
- Amputation claims from medical negligence
- Nerve injury compensation claims
Sources & further reading
Primary statute, case law and regulator guidance referenced in this article.