Compartment syndrome of the hand in an infant

A 12-month-old boy, playing at home, pulled at aheavy weight that fell on his left hand. He wasbrought to the emergency, 7 h after the injury. Onexaminationthechildappearedateasebuthishandwas markedly swollen and rock-hard. The fingerswere splayed out and flexed. There was no localtenderness on gentle pressure nor was passiveabduction or adduction of the fingers painful. Capil-lary refill of the fingers was delayed. Sensory exam-ination was equivocal. No voluntary fingermovement was seen. Radiographs showed a trans-verse fracture of the second and the third meta-carpal shafts (Fig. 1). A diagnosis of compartmentsyndromewasmadeonclinicalgroundsandimmedi-ate fasciotomy performed. Three dorsal longitudi-nal incisions were made over the second, third andthe fourth metacarpal shafts. There was markedsubcutaneous oedema. Using a blunt sinus probeall the dorsal, volar and adductor compartmentswere opened. The muscles were found to be grosslyhaemorrhagic. The hardness, on palpation, had sig-nificantly reduced after decompression. Nothingspecific was done for the fractures. The hand wasdressed, splinted and elevated. After 48 h, thedressing was changed. The wounds were closed onthefifthday.Theparentsdidpassivemobilizationofthe fingers. After 2 weeks the splint was discardedand the child encouraged to use his hand. No resi-dual limitation of function was noted at 18 monthsfollow up.