Acute compartment syndrome (ACS) of the lower leg is a time-sensitive, limb-threatening surgical emergency.

Late findings of ACS can lead to limb amputation, contractures, paralysis, multiorgan failure, and death.

Diagnosis is based on clinical suspicion, assessment of the 6 P’s (pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis), and intracompartmental pressure (ICP).

ICP measurement above 30 mm Hg requires emergent surgical decompression.

The gold standard of ACS treatment is full fasciotomy.