Acute Compartment Syndrome with Multiple Metacarpal Fractures in the Hand of a 5-Year-Old Boy: A Case Report of Successful Resolution with Delayed Primary Closure

<b>Background</b>: acute compartment syndrome (ACS) is an orthopedic emergency characterized by pathological pressure elevation within a confined anatomical space, posing a significant challenge in pediatric patients. ACS affects children in a very limited proportion, particularly involving the upper extremities, and diagnosis is complicated by subtle manifestations compared to adults. <b>Case Presentation</b>: we report on the case of a 5-year-old boy who sustained a crush injury to his right hand, resulting in multiple metacarpal fractures and subsequent ACS. The patient presented with severe pain, hand deformity, and restricted mobility. Radiological evaluation confirmed displaced fractures of multiple metacarpals. Emergency surgical intervention involved six incisions to decompress the dorsal and palmar compartments, release muscles, and decompress the median nerve. Healing involved delayed primary closure monitored every 72 h, resulting in an optimal outcome without complications. <b>Conclusions</b>: pediatric upper extremity ACS is rare, complicating diagnosis and treatment due to limited guidelines. This case underscores the effectiveness of early surgical decompression and delayed primary closure in achieving favorable outcomes. Individualized treatment strategies tailored to anatomical considerations and ACS severity are crucial to optimize patient care in pediatric surgical settings.