Impending compartment syndrome with tibial open fracture in low-resource setting: A case report and literature review

Diagnosing impending compartment syndrome is challenging, particularly in low-resource settings like Indonesia, and carries high morbidity risk. While post-traumatic compartment syndrome is well recognized, impending cases remain underreported. This report describes an impending compartment syndrome following an open tibial fracture after a motor vehicle accident (MVA) in Indonesia. A 24-year-old male presented after a high-speed MVA with severe left leg pain, swelling, and a 3-cm puncture wound on the proximal tibia. Vitals signs were stable, and radiographs revealed an open tibial fracture (Gustilo-Anderson IIIA, Schatzker type VI). Serial neurovascular monitoring was conducted every two hours. Within 12 hours, the patient developed worsening pain disproportionate to the injury, swelling, tense compartments, paraesthesia, and a diminished dorsalis pedis pulse. A clinical diagnosis of impending compartment syndrome was made, and an urgent dual-incision fasciotomy was performed. Impending compartment syndrome is an orthopaedic emergency requiring timely recognition and intervention. In resource-limited settings, early diagnosis depends primarily on careful clinical evaluation and serial examination rather than advanced diagnostic tools. Monitoring every 2–4 hours allows recognition of subtle changes in pain, sensation, and perfusion. • Early detection of compartment syndrome is challenging in low-resource settings. • We report a case of impending compartment syndrome after a motor-vehicle accident. • Serial neurovascular checks enabled early detection without pressure devices. • Dual-incision fasciotomy remains the main treatment for compartment release. • Vigilant observation is vital to prevent complications in limited-resource care.