Is It Compartment Syndrome? Two Case Reports and Literature Review

Recently, a unique entity of acute compartment syndrome (ACS) has been termed "silent" compartment syndrome. These patients develop ACS in the absence of classic pain and physical findings. We report two cases of posttraumatic silent ACS in two healthy competent adult patients presenting mainly with swollen tense compartments. In the first case, ACS was suspected in a 37-year-old male with left tibia and fibula shaft fractures after reassessment of the patient's post-backslap application, which revealed painless swollen and tense compartments. In the second case, ACS suspicion was raised in a 27-year-old male with right comminuted tibial plateau fracture and a swollen but soft compartment that became tense over time. In both cases, intraoperative intracompartmental pressure testing during external fixator application confirmed the diagnosis, and both underwent emergent fasciotomy with good postoperative outcomes. The absence of pain does not exclude the diagnosis of ACS. Physicians must have a high index of suspicion when risk factors are present for ACS, and the diagnosis can be confirmed with intracompartmental pressure measurement. These case reports and literature review aim to enlighten the physicians about silent compartment syndrome.