The laceration associated with an open fracture should not be closed in the ED, even if the fracture is nondisplaced Patients with an open fracture should receive antibiotics as soon as possible to minimize risk of infection Compartment syndrome associated with a fracture can occur in the forearm, hand, leg, or foot, with the leg being the most common location Fractures associated with compartment syndrome not need to be severe Pain out of proportion to the injury or increasing pain after analgesics, especially with passive extension, is one of the earliest signs of compartment syndrome Compartment syndrome may present shortly after the fracture is sustained, or may occur after reduction and casting Therefore, neurovascular status must always be checked in the injured extremity after casting Fasciotomy should be considered when clinical symptoms of compartment syndrome are present and/or when compartment pressures measured in the injured extremity are within 30 mm Hg of the patient’s diastolic blood pressure or the mean arterial pressure Current Evidence A fracture is considered to be “open” when the injury results in disruption of the skin and underlying soft tissues overlying the fracture, thus providing a communication between the fracture and the outside environment The organisms found to be contaminating an open fracture at the time of presentation not necessarily represent the microbes that will eventually cause infection; therefore, wound cultures are of minimal utility Most open fracture infections are caused by gram-negative rods and gram-positive staphylococci; however, clinicians should be mindful of a rising frequency of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) While there is consensus supporting the timing of antibiotic administration to minimize risk of infection, there are variable recommendations on the optimal regimen Children with compartment syndrome may present with only one associated sign or symptom, with pain being the most common presentation In one study of compartment syndrome with tibial shaft fractures, adolescents (14 years and