Background: Management of compartment syndrome in the modern era involves not only avoiding the sequelae of a missed diagnosis but also minimizing the risk of a malpractice claim. Little information is available on the legal aspects of compartment syndrome.

Methods: Twenty-three years of records on closed malpractice claims involving compartment syndrome were reviewed. The data were abstracted from medical records and were analyzed to determine the factors associated with a successful defense.

Results: Nineteen closed claims, involving sixteen patients and encompassing a total liability of $3.8 million, were found in the data for malpractice claims closed between 1980 and 2003. Ten claims were resolved in favor of the physician. The average time to closure was 5.5 years. All three claims that went to trial resulted in a verdict for the physician. Evidence of poor physician-patient communication was found in six cases, all of which resulted in an indemnity payment (p < 0.01). Increasing time from the onset of symptoms to the fasciotomy was linearly associated with an increased indemnity payment (p < 0.05). A fasciotomy performed within eight hours after the first presentation of symptoms was uniformly associated with a successful defense.

Conclusions: While malpractice claims involving compartment syndrome were uncommon, they resulted in a high rate and amount of indemnity payments. Early fasciotomy not only improves patient outcome but is also associated with decreased indemnity risk.