When an ischemic contracture develops after injury it appears that the ischemia has pursued a middle course between full recovery and gangrene. The mechanism of such a pathology is difficult to understand. There appear to be two distinct types of injury that precipitate such a contracture; one where a major vessel is occluded and the ischemic tissue lies distal to the injury; and a second where the injury is a direct one and the ischemia develops at the site of the injury. The ischemic changes that develop after both types of injury appear to be remarkably similar and they develop, almost exclusively, where the tissues involved lie within unyielding osteofascial compartment. In both types, compartmental syndrome could have been precipitated; on the one hand by the ischemia of arterial interruption and on the other by direct tissue damage. Early fasciotomy is advocated after both types of injury, quite apart from any necessary arterial repair.