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

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. ACS can 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 to preserve limb function.