Neonatal Upper Limb Compartment Syndrome Following Uterine Rupture: Conservative Management and 10-Year Outcomes

Neonatal compartment syndrome of the upper limb is documented in fewer than 100 cases. Recognition is difficult as clinical signs are subtle, diagnostic pressure thresholds in newborns are not established, and the condition is frequently mistaken for birth trauma. Fasciotomy within the first 24 hours is the standard of care, though whether this is always necessary remains debated. We present a case of a premature neonate who developed upper limb compartment syndrome following an unusual mechanism of injury, with 10 years of clinical follow-up. The published literature is reviewed with focus on aetiology, diagnostic challenges, management, and long-term outcomes. A 32-week neonate was delivered by emergency caesarean section following uterine rupture, in which the right arm had extruded through a uterine wall defect at a previous myomectomy scar. The infant presented with a bullous sentinel lesion, global limb swelling, and minimal spontaneous movement. Doppler ultrasound confirmed residual arterial flow and, unlike most published cases, the compressive insult had been definitively relieved at delivery. The infant was managed conservatively with serial neurovascular monitoring. Limb perfusion improved within 24 to 48 hours without surgical intervention. At 10-year follow-up, the child has normal strength, full range of motion, and no limb length discrepancy. This case demonstrates that the mechanism of injury should factor explicitly into management decisions in neonatal compartment syndrome. Where extrinsic compression has been definitively relieved and perfusion confirmed, a closely monitored non-operative approach may be appropriate. Long-term follow-up remains underreported.