Compartment syndrome (CS) is one of the true surgical emergencies in orthopaedic trauma, and the sequelae of a missed diagnosis can have serious implications. The development of a CS begins at the microvascular level with disruption of the homeostatic environment between venous pressure, arterial flow, and intracompartmental tissue pressure. While the pathophysiology has been previously described in the literature, there remain diagnostic challenges and some question regarding the clinical utility and reliability of clinical symptoms and the physical exam-particularly in the compromised, obtunded, or pediatric patient. Early and complete fasciotomy has been shown to decrease the rates of adverse complications, however is not without some morbidity. Some of the challenges and newer diagnostic modalities in the identification of CS are reviewed as well as different fasciotomy techniques and other important concepts in the pathophysiology, outcomes, and medicolegal implications of this condition.
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