We are in the emergency department at our local hospital. I need some advice quick. The surgeons are consulting to see if our 14-year-old son needs surgery for something they are calling “compartment syndrome.” He’s already in a cast for a broken leg. But his toes went numb and the leg kept giving out from under him. Of course, it’s the weekend and his orthopedic surgeon isn’t on call. Guide me through how this decision will be made so I know if we are on the right track.

Compartment syndrome describes a condition in which fluid (swelling or blood) builds up inside one or more of the individual compartments of the leg (or arm). Traumatic injuries, especially bone fractures that puncture the soft tissues are a common cause of compartment syndrome. Pain out of proportion to the injury, pain that isn’t relieved by medications, and increased use of pain medication (e.g., narcotics) are early signs of a potential problem.

Usually an X-ray will show if the bones have shifted position from when your son was placed in the cast. But even with an X-ray, it isn’t always possible to detect compartment syndrome. The next step will be to remove the cast. Usually the surgeon or emergency department physician/staff will bivalve the cast (cut it in half, lengthwise) and just remove the front portion. If taking pressure off the leg relieves the symptoms, it’s a sign that your son may have been experiencing the start of a compartment syndrome.

Failure to experience relief of symptoms with half-cast removal is a red flag for compartment syndrome. An emergency fasciotomy is done. In this procedure, the surgeon cuts through the fascia or connective tissue around the muscles of the leg forming four distinct compartments. The purpose is to take pressure off the soft tissues.