Hand and Forearm Compartment Syndrome Secondary to Intravenous Infiltration

Acute compartment syndrome (ACS) in the hand and forearm is an uncommon yet significant orthopedic crisis. The misplacement or migration of an intravenous (IV) catheter can cause fluid extravasation into interstitial tissues, which is a rare but known cause of ACS. Diagnosis of ACS is usually clinical, but this can be challenging in anesthetized or obtunded patients who are unable to communicate. Management involves emergent fasciotomies to relieve compartment pressures.

We present the case of a 64-year-old female who developed ACS in the hand and forearm following a carotid endarterectomy. The patient experienced significant swelling in her left hand and forearm due to an infiltrated IV catheter. The diagnosis was based solely on physical examination, as the patient was under anesthesia. Findings included swelling, tissue tension, and color changes suggestive of early ischemia. Emergent fasciotomies were performed to decompress the affected compartments.

ACS resulting from iatrogenic fluid extravasation is a severe condition with a rare etiology. Prompt identification and surgical intervention are essential to reduce associated morbidity and mortality. In certain cases, the diagnosis must be made by physical examination alone. The rarity of this etiology necessitates heightened awareness among inpatients who have a limited ability to communicate.