That's a wrap – the use of an Esmarch bandage to treat compartment syndrome of the forearm in a paediatric patient

A 13 year old boy presented to our emergency department after a fall from his bicycle and sustained a left radius & ulna fracture. The boy had paraesthesia and reduced sensation in his digits. AIN and PIN were intact. He underwent MUA & casting in theatre. He had significant swelling, paraesthesia and severe pain with passive movement of his digits post-op. A diagnosis of compartment syndrome with suspected acute carpal tunnel syndrome was made. Flexor compartment pressure was 68 mmHg and 16 mmHg in the extensor compartment. An Esmarch bandage was temporarily applied in a retrograde fashion from distal to proximal on the elevated limb. The technique was repeated 4 times and final flexor compartment pressure was 23 mmHg. Based on these measurements, carpal tunnel release and distal radius fixation was performed, but no fasciotomy. He remained asymptomatic throughout follow-up and was subsequently discharged from the fracture clinic. We have described a successful case of treating forearm compartment syndrome in the setting of a paediatric forearm fracture conservatively, without the need for a fasciotomy. We demonstrated an objective improvement in compartment pressures with repeated applications of the Esmarch bandage technique. It is quick to implement and safe for the patient. We advocate its use in those patients where a fasciotomy is already planned as that remains the gold standard treatment. This technique should be used to potentially avoid a fasciotomy and the subsequent morbidity associated with that surgical procedure. It should be used in conjunction with sound clinical judgment and examination technique.