Acute Pediatric Hand Compartment Syndrome Following Metacarpal Fractures: A Case Report.

Acute compartment syndrome (ACS) of the hand is a rare but potentially devastating condition in children, particularly in young patients, in whom diagnosis may be difficult due to unreliable clinical signs. We report the case of a three-year-old girl admitted following bicycle-wheel trauma to the hand, with fractures of the bases of the second and third metacarpals. Progressive pain, worsening edema, and increasing compartment tension raised suspicion for ACS. Urgent fasciotomy was performed approximately two hours after admission using two dorsal incisions over the second and fourth metacarpals and a volar thenar approach, associated with retrograde Kirschner wire (K-wire) fixation. Selective decompression was performed without hypothenar or carpal tunnel release, as no signs of involvement were identified. Fasciotomy closure was achieved four days later, and the patient was discharged on the fifth day after admission. K-wires were removed four weeks postoperatively following radiographic fracture healing. At the three-month follow-up, the patient presented with full hand mobility and excellent functional recovery without formal rehabilitation. At the six-month follow-up, she remained asymptomatic with no evidence of late complications or deformity. Our case supports the role of serial clinical assessment, early surgical intervention, and individualized decompression strategies in pediatric hand compartment syndrome.