Introduction <p>: Acute compartment syndrome (ACS) is a devastating and time-sensitive emergency that increases limb disabilities, amputations, and deaths annually. However, there is a paucity of data on the incidence of ACS in tibia fractures and its predictors in Uganda that can help us save the limb. This study aimed to determine the incidence of ACS in tibia fractures and its predictors in Uganda.</p> Methods <p>A prospective cohort study was conducted for 6 months at three tertiary hospitals in Uganda where patients with tibia fractures were examined clinically and had their intracompartmental pressure (ICP) measured for ACS using the Whitesides technique, with a 24-hour follow-up after admission and after orthopaedic treatment. All patients were managed as per the ATLS protocol; Data were analyzed using SPSS version 22.</p> Results <p>The study enrolled 130 study participants with tibia fracture. The majority of participants were males (76.9%). The age group of 18–30 years made up 55.4%. The incidence of ACS was found to be 8.5% (11/130). Among the 11 people with ACS, all had both tibia and fibula fractures, and 8/11 had closed fractures. Smoking (aRR = 2.189, CI = 1.614–7.812, <i>P</i> = 0.049) and swelling of the injured limb (aRR = 3.793, CI = 1.479–9.727, <i>P</i> = 0.008) were the independent predictors of ACS.</p> Conclusion <p>The incidence of ACS in Uganda was 8.5%. People with a history of cigarette smoking and clinical symptoms of swelling of the limb should be monitored more closely.</p> Clinical trial number <p>Not applicable.</p>