Endgames Case Report

A boy with a painful arm

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c5972 (Published 16 February 2011) Cite this as: BMJ 2011;342:c5972
  1. D A Pettitt, surgeon1,
  2. P McArthur, professor2
  1. 1University of Liverpool, Liverpool L69 3BX, UK
  2. 2Whiston Hospital, Prescot, Merseyside, UK
  1. Correspondence to: D A Pettitt d.pettitt{at}liv.ac.uk

A healthy 8 year old boy, with no history of surgery or medical conditions, presented to the accident and emergency department with severe pain in his right arm after falling off a four foot wall. He had a painful, tender, and swollen right elbow, which he was hesitant to move. The radial pulse was not palpable on examination. Radiography confirmed that he had a right supracondylar fracture of the humerus (Gartland type III, completely displaced). He was treated urgently by open reduction and internal fixation with K wires. After surgery, the radial pulse was still not palpable, although his fingers showed good capillary refill and pain was initially absent on extension. During the postoperative period, the arm became increasingly painful. The pain was “out of proportion” to the nature of the injury and required increasing doses of analgesia. The arm was also notably warm and swollen; palpation showed a tense forearm with extremely reduced capillary refill.


  • 1 What is the most likely diagnosis?

  • 2 What is the pathological process?

  • 3 How should such patients be monitored?

  • 4 What is the appropriate management for this patient?

  • 5 What are the possible complications if the condition is left untreated?


1 What is the most likely diagnosis?

Short answer

The most likely diagnosis is an acute compartment syndrome.

Long answer

A diagnosis of compartment syndrome is primarily based on signs of …

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