Sheridan and Matsen retrospectively analyzed 44 patients (46 extremities, 66 compartments) treated with fasciotomy for acute compartment syndrome at University of Washington hospitals over 10 years. The study asked whether timing of decompression and open vs. closed technique affect functional outcomes and complications. It established the 12-hour threshold as the critical window for limb-saving fasciotomy.
A 12-hour window separates salvageable limbs from those with irreversible necrosis. This paper is why compartment syndrome is taught as a surgical emergency, not a watchful-waiting diagnosis.
When your patient after tibia fracture or revascularization develops pain with passive stretch, weakness, or hypoesthesia, the clock starts. Do not wait for pressure measurements to confirm what the clinical exam already shows. Get to the OR.
Pain alone is explicitly unreliable as a sole indicator — the paper calls out motor weakness, passive stretch pain, and nerve hypoesthesia as the signs to monitor serially in at-risk extremities.
If you decompress late, expect a 46% infection rate, a 21% amputation rate, and a hospital stay nearly 2.5 times longer. The biology is unforgiving: 12 hours of ischemia produces essentially complete muscle fiber necrosis, and decompressing dead muscle only creates an infected wound.
Sheridan and Matsen retrospectively analyzed 44 patients (46 extremities, 66 compartments) treated with fasciotomy for acute compartment syndrome at University of Washington hospitals over 10 years. The study asked whether timing of decompression and open vs. closed technique affect functional outcomes and complications. It established the 12-hour threshold as the critical window for limb-saving fasciotomy.
A 12-hour window separates salvageable limbs from those with irreversible necrosis. This paper is why compartment syndrome is taught as a surgical emergency, not a watchful-waiting diagnosis.
When your patient after tibia fracture or revascularization develops pain with passive stretch, weakness, or hypoesthesia, the clock starts. Do not wait for pressure measurements to confirm what the clinical exam already shows. Get to the OR.
Pain alone is explicitly unreliable as a sole indicator — the paper calls out motor weakness, passive stretch pain, and nerve hypoesthesia as the signs to monitor serially in at-risk extremities.
If you decompress late, expect a 46% infection rate, a 21% amputation rate, and a hospital stay nearly 2.5 times longer. The biology is unforgiving: 12 hours of ischemia produces essentially complete muscle fiber necrosis, and decompressing dead muscle only creates an infected wound.