Atypical Signs of Compartment Syndrome Caused by Pressure Injury in Forearm

Abstract

Acute compartment syndrome (ACS) is a serious complication which is usually associated with fractures. Herein, we report a case of a patient with volar forearm compartment syndrome associated with closed muscle rupture without fracture of which the only external signs were superficial contact burns and pain. A 21-year-old man presented to our emergency department with painful swelling in the right forearm after being caught in a machine. Although he presented with pain, no open wound or fracture was seen. The patient was presumed to have a contusion and discharged. He presented with worsening pain the next day, when typical clinical features of ACS were observed and emergency fasciotomy was performed. Intraoperatively, ruptured flexor muscles were noted. Delayed presentation of forearm compartment syndrome accompanied by closed muscle rupture without fracture is extremely rare. Diagnosis is not easy because severe pain could be the only clue and can mask the signs of compartment syndrome, at risk of being missed.