The acute compartment syndrome occurs when increased pressure within osteofascial compartments results in local muscle ischaemia. If left untreated it may lead to muscle necrosis and contractures. The systemic manifestations of this - the crush syndrome - are the results of haemodynamic and metabolic disburbances and acute renal failure.1 Failure to appreciate the importance of muscle necrosis as the underlying problem in the crush syndrome may have disastrous consequences.

The crush syndrome was originally described during the London Blitz in civilians who had been buried beneath the debris of destroyed houses.2 Nowadays, victims are typically encountered in war zones, in mining disasters, after earthquakes, and in industrial or road traffic accidents.3 The syndrome may also develop after isolated compression of arms or legs by the victim's own body - for example, during unconsciousness after a drug overdose.1 Such patients often delay seeking medical attention or have other more apparent complications that need urgent attention. The local signs of muscle compression and necrosis may therefore initially be overlooked. We describe 11 such cases referred to our unit over 51 months.