There is a elevated risk of acute compartment syndrome (ACS) related to tibial shaft
fractures due to oedema and reduced blood flow in traumatised tissues. This may lead to lack
of oxygen and even necrosis. Symptoms of ACS are severe pain, hypoaesthesia, pain during
flexion of the ankle and swollen leg in clinical examination. Paralysis and lack of distal
pulses are late symptoms of ACS.

Many experts think that effective relief of pain caused by regional anaesthesia (RA) may hide
the symptoms of the ACS. This may be incorrect. The evidence of dangers related to RA is
based on old patient-series and single case-reports. Some of these studies report the
symptoms of ACS (hypaesthesia and even pain) being caused by RA. Majority of the conclusions
in these studies cannot be confirmed by an expert of RA. It is also possible that there are
more hemodynamic changes related to general anaesthesia (GA) which may predispose to ACS.
There are no modern, randomized and controlled studies of the safety of RA in patients with
tibial shaft fracture.