Rheumatology and Musculoskeletalmiddle twist
A 19-year-old man had a closed mid-shaft tibial fracture reduced and placed in a below-knee cast eight hours ago after a football tackle. He now has severe pain in the calf that has not responded to intravenous morphine. The cast has been split to skin and the padding released 30 minutes ago; the pain has not improved. The calf compartment is tense and passive stretching of the toes into dorsiflexion produces agonising pain. The dorsalis pedis pulse is palpable and capillary refill in the toes is 2 seconds. Sensation between the first and second toes is reduced.
Which one of the following is the most appropriate management?