Compartment syndrome without pain!

We report the case of a young male patient who underwent intra-medullary nailing for a closed, displaced mid-shaft fracture of tibia and fibula. He was commenced on patient controlled analgesia post-operatively. A diagnosis of compartment syndrome in the patient's leg was delayed because he did not exhibit a pain response. This ultimately resulted in a below-knee amputation of the patient's leg. We caution against the use of patient controlled analgesia in any traumatised limb distal to the hip or the shoulder.