Atypical Presentation of Acute Compartment Syndrome in the Lower Limb: A Case Report of When Pain Does Not Guide the Diagnosis.

Acute compartment syndrome (ACS) is a surgical emergency that, if not promptly treated, can lead to muscle necrosis, limb loss, or death. Although disproportionate pain is traditionally considered the hallmark symptom, atypical presentations without pain have been described. We report the case of a 42-year-old male who sustained multiple traumatic injuries in a motorcycle-vehicle collision and subsequently developed silent compartment syndrome in the left thigh and leg. Despite being conscious and neurologically intact, the patient did not report significant pain at any point. The diagnosis was suspected based on objective findings, including tense edema, absent distal pulses, and progressive motor dysfunction. Invasive compartment pressure measurements confirmed the diagnosis, leading to urgent fasciotomies and intensive care management, including renal replacement therapy. This case highlights the importance of maintaining a high index of suspicion for ACS in patients with major trauma, even in the absence of pain, and supports early intervention to prevent irreversible sequelae.