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Neonatal Compartment Syndrome of the Forearm

· Healthcare,neonatal,Compartment Syndrome,Orthopaedics,Orthopedic Surgery

There are only a few cases of compartment syndrome in the neonate. This can be a difficult diagnosis. Compartment syndrome in the neonate does not present itself with the classic P’s as seen in adult patients (Pain/Swelling/ Paresthesia, Pulselessness, Pallor, Paralysis). Diagnosis in the neonate is usually made retrospectively after the patient has complications. The condition of compartment syndrome usually occurs within the first 24 hours of birth. It usually occurs in the forearm, unilaterally, and more in the dorsal aspect of the forearm.

Risk factors for compartment syndrome in neonatal patients:

  • Diabetic mother

  • Some hypercoagulable state

    • Polycythemia

  • Prematurity

The actual cause if not known; however, it can be a combination of extrinsic compression and hypercoagulable state. It is important to avoid missing the diagnosis of compartment syndrome. The infant will have a swollen tense forearm associated with skin lesions on the forearm. The skin may have erythema, bullae, and edema.

The skin lesions will be present at birth, and usually located at the forearm. The patient may also have pseudoparalysis, lack spontaneous limb movement, and a possible nerve injury. The clinical diagnosis of compartment syndrome will be made after exclusion of other conditions such as infection, vascular injury, and amniotic band syndrome. Infection may be present in the form of cellulitis or necrotizing fasciitis. Both should be excluded. Treatment of neonatal compartment syndrome of the forearm should be diagnosed early and immediate fasciotomy should be performed. Ischemic muscle contracture could develop due to missing the diagnosis and the delay in treatment.

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