Diagnosis of acute compartment syndrome: current diagnostic parameters

Acute Compartment Syndrome (ACS) is a time-critical, limb-threatening condition best characterized by increased intracompartmental pressure that compromises tissue perfusion, leading to ischemia, hypoxia, and ultimately irreversible necrosis. Fractures to the extremities account for >80 % of all ACS cases, and those involving the tibia account for more than two-thirds of all ACS cases. Open fractures and those secondary to high-energy trauma and penetrating injuries like gunshots are at higher risk of ACS. Despite decades of research and technological advancement, early diagnosis has remained a significant clinical challenge due to the nonspecific symptoms and the absence of a definitive diagnostic gold standard. This review aims to provide a comprehensive overview of the pathophysiology, risk factors, diagnostic modalities, and current challenges associated with ACS. It emphasizes the importance of shifting the diagnostic paradigm from binary criteria toward objective outcome-based clinical decision-making. ACS should be redefined as a pathophysiological continuum rather than a binary diagnosis. Accurate, early recognition, and timely intervention are crucial for minimizing long-term morbidity. Future diagnostic approaches should prioritize objective markers of tissue health and clinical outcomes over static thresholds. Several learned bodies have recommended continuous pressure measurement, which is seen in the newer literature as highly accurate. Continued research is needed to develop standardized classification systems or treatment protocols.