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학습 자료 둘러보기 →In a patient with a fracture and signs of shock, new-onset paresthesia and pallor are the most concerning findings. They indicate acute compartment syndrome (ACS), where rising intracompartmental pressure collapses the microvasculature, causing nerve ischemia before arterial inflow ceases.
The definitive treatment is a timely fasciotomy. Delays beyond 4-6 hours of ischemia lead to irreversible muscle necrosis, contractures, and potential limb loss. Systemic complications include rhabdomyolysis and acute renal failure.
Do not wait for pulselessness to diagnose ACS; it is a late sign. Pain out of proportion to the injury and pain with passive stretch are earlier indicators. Absent pulses may indicate a primary vascular injury, which must also be ruled out.
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