Extremity Fracture, Long Bone Open Fracture — Neurovascular Assessment — Clinical Pathway: Emergency

Neurovascular Assessment

Patients with the following injuries are at risk for Acute Limb Compartment Syndrome (ALCS):

  • Displaced tibia or forearm fracture (before and after reduction)
  • Displaced supracondylar humerus fractures, especially with an associated distal radius fracture/compromised pulses
  • Soft tissue crush injuries
  • Re-vascularized limbs
  • Following orthopedic surgery for the above injuries or osteotomies
  • Subfascial IV infiltrates (such as with intraosseous lines)
  • Limb gunshot wounds

Neurovascular Exam

Reassess and document:

  • After splinting, casting and reduction
  • Increasing pain in spite of adequate analgesia
  • Patient complaint of paresthesias
  • For patients at risk for ACS
    • RN: Assess NV status hourly
    • MD: Assess every 2-4 hours


Skin color Well-perfused, pink, pallor, dusky
Capillary refill < 2 seconds
  • 0 = no pulse
  • 1 = weak, easily obliterated with pressure
  • 2 = difficult to palpate, easy to feel when located
  • 3 = easily palpated, normal
  • 4 = strong
  • 5 = bounding
Upper Extremity Radial, Ulnar
Lower Extremity Dorsalis Pedis, Posterior Tibial