Antero-posterior x-ray of unstable pertrochanteric fracture sustained after simple fall by an elderly patient. Eighteen hours after the injury he started developing signs of acute thigh compartment syndrome and was taken urgently to operating room for anterior thigh compartment fasciotomy. Muscles were still valuable and fracture fixation with cephalomedullary nail was done immediately after. Patient did not have any history of hemorrhagic diathesis, was not taking any blood thinners and there were no abnormalities on patient routine preoperative workup (PT, PTT, INR, platelets). He recuperated well.