Unmasking Compartment Syndrome in an Autistic Adolescent: A Case of Median Nerve Compression Following Distal Radius Open Reduction and Internal Fixation (ORIF)

Acute compartment syndrome is a rare but limb-threatening complication of trauma and surgery. In neurotypical patients, pain out of proportion to injury is a key diagnostic clue. In autistic and other neurodivergent individuals, altered sensory processing and communication barriers can mask or distort pain reporting, delaying recognition. We present an adolescent male with autism who sustained a comminuted right distal radius fracture in a high-speed motorbike collision. Following open reduction and internal fixation (ORIF), he developed median nerve compression and impending compartment syndrome, requiring urgent fasciotomy and carpal tunnel release. This case highlights diagnostic challenges in neurodivergent trauma patients and the need for tailored, coordinated care pathways.