older) had an increased risk of compartment syndrome compared with younger children Clinical Considerations Clinical Recognition Open fractures typically occur due to a high-energy mechanism; therefore, a complete examination to identify other potentially life-threatening injuries is imperative A fractured extremity should be carefully examined for the presence of an open wound, potentially signifying an open fracture However, it is not always obvious if the injury is an open fracture or if it is a laceration that does not communicate with the fracture Operative exploration by the orthopedist may be necessary to determine this Compartment syndrome develops when there is an accumulation of intracompartmental pressure resulting in obstruction of venous outflow and then increased pressure in the nonelastic compartment If untreated, small arterioles and capillaries are eventually occluded, resulting in ischemia with irreversible muscle and neurovascular tissue damage Compartment syndrome must be suspected with any fracture or blunt tissue injury when there is pain out of proportion to the injury or if the pain is increasing, despite analgesic administration The patient may also complain of paresthesias and pain with passive extension On physical examination the patient may have pallor and pulselessness of the injured extremity, although these may be late findings Triage Considerations Children presenting with a concern for an open fracture or compartment syndrome should be evaluated immediately in the ED with urgent orthopedic consultation Clinical Assessment For open fractures, the wound should be carefully examined and considered in the context of the fracture location With compartment syndrome, the extremity may be pale and the muscular compartments may be swollen and feel hard and tense The pulses may be diminished or absent and the limb may have paralysis or muscle weakness Children may present with only a single sign or symptom of compartment syndrome Management