A patient with a closed tibial fracture develops severe, disproportionate leg pain. What is the most sensitive early clinical finding of acute compartment syndrome?

Answer and explanation

Correct answer: C. Severe pain during passive stretch of compartment muscles

  1. Step 1: Elevated tissue pressure within an enclosed fascial space compromises microvascular perfusion, leading to muscle and nerve ischemia.
  2. Step 2: Severe pain out of proportion to the injury that is exacerbated by passive stretching of the muscles within the affected compartment is the most sensitive early clinical indicator.
Answer
Severe pain during passive stretch of compartment muscles.
Why not the others: Pulselessness is an ominous late finding indicating complete arterial occlusion and impending irreversible tissue gangrene. Complete motor paralysis is a late sign of irreversible nerve necrosis. Pallor and coldness are late manifestations of advanced ischemia.

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