Which clinical assessment finding is the earliest and most sensitive indicator of developing acute compartment syndrome in a limb following a closed tibial fracture?

Answer and explanation

Correct answer: A. Disproportionate pain exacerbated by passive muscle stretch

  1. Step 1: Acute compartment syndrome involves elevated intracompartmental tissue pressure exceeding capillary perfusion pressure.
  2. Step 2: Severe pain out of proportion to the injury that is intensely exacerbated by passive stretching of the muscles within the affected compartment is the earliest, most sensitive diagnostic warning sign. Pulselessness, paralysis, and pallor are late signs signaling irreversible necrosis.
Answer
Disproportionate pain exacerbated by passive muscle stretch.
Why not the others: Pulselessness, paralysis, and pallor represent late irreversible tissue ischemia and must not be waited on before emergent fasciotomy.

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