When should I refer a patient with suspected compartment syndrome to secondary care for further management?

Refer a patient with suspected compartment syndrome to secondary care immediately for urgent assessment and management. This is particularly critical if the patient has a fracture, especially of the tibia, or if there are clinical signs suggestive of compartment syndrome such as severe pain disproportionate to the injury, pain on passive stretch, tense swollen compartments, or neurological symptoms. In hospital settings, continuous compartment pressure monitoring may be considered if clinical signs are unclear, for example, if the patient is unconscious or has a nerve block. Patients with suspected compartment syndrome require urgent surgical intervention (fasciotomy) to prevent permanent tissue damage, so prompt referral to an orthopaedic or trauma specialist is essential NICE NG37.

Additionally, patients with fractures at risk of compartment syndrome should be monitored closely for at least 48 hours after injury or fixation, with regular clinical assessment and documentation of symptoms and signs. Patients discharged from hospital after such injuries should be advised on how to self-monitor for symptoms of compartment syndrome and instructed to seek immediate medical attention if symptoms develop NICE NG37.