Atypical presentation of forearm compartment syndrome in a child.

Compartment syndrome (CS) in children is rare in the paediatric population and diagnosis is challenging. Atypical or delayed management of CS has been known to have poor outcomes. We report an 8-year-old girl with an atypical presentation of CS and her management. In this case report, we discuss the case of an 8-year-old girl with an open fracture of the midshaft radius and ulna fracture managed with Titanium elastic nailing system (TENS). She presented 2 weeks post injury with significant pain, flexed fingers and agitated. Following an urgent forearm fasciotomy and carpal tunnel decompression, her symptoms improved. 72 hours later, her fasciotomy wounds were closed and her symptoms continued to improve. 9 weeks post injury her forearm fracture had radiological union. 6 months post injury her TENS nails were removed.8 months post injury, she had no functional motor deficit but residual sensory deficit in median nerve distribution. CS requires a high index of suspicion in the paediatric population. In addition to cardinal 5P's signs of CS, a triad of 3A's has been proposed for diagnosis of CS in children. Long term outcomes are favourable in atypical presentations or delayed diagnosis cases.