Ultrasound in acute compartment syndrome of the extremities

Acute compartment syndrome (ACS) is a surgical emergency that remains challenging to diagnose. Diagnosis is primarily clinical, with invasive intracompartmental pressure (ICP) monitoring recommended when available. However, clinical findings can be unreliable, and invasive ICP measurement carries procedural risks. Ultrasound has increasingly been investigated as a noninvasive diagnostic method for ACS. This review analyzed all reported uses of ultrasound in the context of ACS. Six primary ultrasound techniques were identified: conventional two-dimensional (2D) ultrasound, Doppler ultrasound, pulse phase-locked loop (PPLL) ultrasound, contrast-enhanced ultrasound (CEUS), pressure-related ultrasound (PrUS), and shear-wave elastography (SWE). Each method was described according to its mechanism and theoretical basis, then evaluated for its current clinical relevance. SWE appeared to hold the greatest promise for clinical implementation, with additional potential noted for Doppler ultrasound and tibial fascia angle (TFA) measurements. PrUS, CEUS, and PPLL showed practical limitations that currently restrict clinical application, though further research may address these concerns. Ultrasound offers a noninvasive, repeatable means of quantitatively assessing multiple compartments without the pain or infection risk associated with invasive ICP monitoring. While several methods demonstrate promise, none have yet been validated for clinical adoption. Larger, standardized clinical trials are needed to confirm their diagnostic accuracy and utility.