Acute Compartment Syndrome Following Non-Displaced Proximal Ulnar and Distal Radial Fractures in a Four-Year-Old Girl - Case Report

Sep 28, 2026

Acute compartment syndrome (ACS) is a rare but limb-threatening emergency in children, often linked to displaced fractures, crush injuries, or high-energy trauma. This report presents an unusual ACS case after non-displaced fractures, challenging traditional risk factors. A healthy 4-year-old girl developed severe forearm pain, swelling, absent radial pulse, delayed capillary refill, and cold digits 12 hours after a fall. Radiographs showed non-displaced proximal ulna and distal radius fractures. Emergency fasciotomy was performed to preserve limb function, emphasizing early recognition and clinical suspicion.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Abstract

Introduction

Pathophysiology and anatomical considerations

Causes and incidence

Diagnosis in children

Prognosis and literature gap

Case Report

Case Report J Med Cases. 2026;17(1):37-40 Acute Compartment Syndrome Following Non-Displaced Proximal Ulnar and Distal Radial Fracturesin a Four-Year-Old Girl Khalid Aloqeelya, Amal Yousifb, d, Fatima Aljaziric Abstract Acute compartment syndrome (ACS) is a rare but limb-threatening emergency in children, usually associated with displaced fractures, crush injuries, or high-energy trauma. Prompt recognition and fasciotomy are essential to prevent permanent disability. An unusual case of ACS after non-displaced fractures is presented, challenging traditional risk factors. A healthy 4-year-old girl presented 12 h after a 2-m fall with severe forearm pain, swelling, an absent radial pulse, delayed capillary refill (3-4 s), and cold digits. Radiographs showed non-displaced proximal ulna and distal radius fractures. Emergency fasciotomy was performed based on clinical findings of ACS. ACScan occur in children after non-displaced fractures, even without conventional risk factors. Clinicians should rely on careful neurovascular assessment and clinical suspicion rather than fracture type or mechanism alone. Early recognition and surgical intervention are critical topreserve limb function. Keywords: Acute compartment syndrome; Non-displaced fractures; Early recognition; Intervention; Children Introduction Acute compartment syndrome (ACS) is a medical emergency characterized by elevated interstitial pressure within a closed osteofascial compartment, leading to decreased tissue perfusion and ischemia [1]. The pathophysiological cascade typical- Manuscript submitted October 14, 2025, accepted December 12, 2025 Published online December 24, 2025 aDepartment of General Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia bDepartment of Emergency Medicine-Pediatric Emergency Unit, King Saud University Medical City, Riyadh, Saudi Arabia cPediatric Emergency Department, Maternity and Children Hospital, Dammam, Saudi Arabia dCorresponding Author: Amal Yousif, Department of Emergency MedicinePediatric Emergency Unit, King Saud University Medical City, Riyadh, Saudi Arabia. Email: [dr.amalyousif@gmail.com](dr.amalyousif@gmail.com) doi: [https://doi.org/10.14740/jmc5223](https://doi.org/10.14740/jmc5223) ly begins with edema or bleeding in a fixed-volume compartment, raising venous and tissue pressure. When compartment pressure exceeds capillary perfusion pressure, muscle and nerve ischemia ensue [1]. Although this model presents a plausible, linear cascade of events, it is important to recognize that more complex mechanisms for this pathophysiology have also been described in the literature [2] . In the upper extremity, ACS involves several anatomical considerations. The forearm contains three main compartments: the volar compartment, the dorsal compartment, and the mobile wad (brachioradialis, extensor carpi radialis longus, and brevis), which primarily contains muscles involved in elbow flexion and wrist extension. The hand alone has ten distinct fascial compartments [1] . Fractures are the principal cause of ACS [3, 4], although iatrogenic causes have also been reported [5] . Atraumatic causes including hereditary angioedema, cellulitis, and osteomyelitis have also been reported [4, 6-9] . The incidence is fortunately rare, affecting 0.3% of pediatric patients after trauma [10] . The median age at presentation is 12 years, with girls accounting for 20% of cases compared to boys [11] . The upper limb is involved in 40% of cases compared to the lower limb [12], and the hand is affected in 35% of cases compared to the forearm [4] . Supracondylar fracture (SCF) is classically associated with pediatric ACS, most often involving the volar forearm compartment, but its incidence is still only 0.1-0.3%[13, 14] . Reported risk factors include male sex, high-energy trauma, and concomitant humeral and forearm fractures [15, 16] . Diagnosis of ACS is primarily clinical, based on findings such as severe pa

FAQs

What makes acute compartment syndrome (ACS) dangerous in children?

ACS is a limb-threatening emergency caused by elevated interstitial pressure in a closed compartment, leading to decreased tissue perfusion and ischemia. If not recognized quickly, it can result in permanent disability.

Why does this case challenge traditional ACS risk factors?

The report describes ACS occurring after non-displaced fractures, even though ACS is usually associated with displaced fractures, crush injuries, or high-energy trauma. This highlights that clinicians should not rely on fracture type or mechanism alone.

What is the basis for diagnosing ACS in this context?

Diagnosis is primarily clinical, using findings such as severe pain, pain with passive movement, swelling, paresthesia, and diminished pulses. Ancillary investigations may assist when findings are equivocal, especially in very young children.

Sep 28, 2026

Uploaded by Alex Sinclair