A patient in the ED has a closed comminuted tibia fracture and presents with a tense, shiny leg and requests more pain meds. What should you be most concerned about?

• A. That you may have missed a vascular injury
• B. That the patient has developed an open fracture
• C. That the patient has developed compartment syndrome
• D. That the patient has developed cellulitis

Answer: (C)

The situation described, involving a closed comminuted tibia fracture and the presence of a tense, shiny leg, raises significant concern for compartment syndrome. Compartment syndrome occurs when increased pressure within a closed muscle compartment compromises blood flow and tissue perfusion. The tense and shiny appearance of the leg is indicative of edema and possibly elevated intracompartmental pressures, which can lead to serious complications, including muscle necrosis and permanent functional impairment if not recognized and treated promptly.

In this case, the patient's request for more pain medications further suggests that they are experiencing significant pain, which is a hallmark symptom of compartment syndrome. As pressure continues to build, the perception of pain can exceed what would be expected from the injury alone, signaling that immediate intervention may be necessary to alleviate the pressure.

While vascular injuries and infections like cellulitis are important considerations in the context of trauma, the specific signs and symptoms presented in this scenario align more closely with the diagnosis of compartment syndrome. Recognizing this condition and acting swiftly to relieve the pressure—often through fasciotomy—can be crucial for preserving muscle and nerve function in the affected limb.