Acute Compartment Syndrome of the Hand in a 14-Month-Old Child: A Case Report

Abstract

Background: Compartment syndrome is a well-known entity, but it is rare in the pediatric population, and its diagnosis is quite challenging. We report a case of an acute compartment syndrome (ACS) of the hand, developed after a crushing trauma, in a 14-month-old boy. Case Report: A 14-month-old boy presented to the Emergency Department following a crushing trauma to his right hand. The patient had a progressive swelling of the right hand and agitation. On physical examination, the right hand was tense, swollen, with areas of skin necrosis and blisters, along with increased agitation upon palpation. Laboratory tests revealed elevated white blood cells, creatinine kinase, and erythrocyte sedimentation rate. Radiographic imaging showed deviated diaphyseal fractures in the second, third, fourth, and fifth metacarpals. A diagnosis of ACS of the hand was made. After draining the blisters, multiple fasciotomies were carried out to all 11 compartments of the hand. The metacarpal fractures were managed conservatively with a wrist splint for one month. A clinical and radiological follow-up after 7 months showed a complete functional recovery of the right hand and consolidation of the 2nd, 4th, and 5th metacarpal fractures, while the 3rd metacarpal fracture showed pseudoarthrosis. Conclusion: Compartment syndrome of the hand in children is a rare condition, and its clinical picture may differ from that in adults, leading to a misdiagnosis or late diagnosis in many cases. Our case emphasizes the importance of a careful clinical evaluation in children post-trauma to diagnose such a condition.