The case described in our study is that of a 76-year-old woman with a history of arterial hypertension and carcinoma of the rectum treated 15 years ago with radiotherapy, surgery and chemotherapy, in complete remission at that time. She was receiving outpatient treatment with opioid analgesics, monitored by the Pain Unit, for generalised osteoarthritis.
In September 2013, this patient attended the Emergency Department with acute chest pain that was diagnosed as NSTEACS-Killip III, assessed by the Cardiology Department, a loading dose of Prasugrel and acetylsalicylic acid was started, and it was decided to perform primary percutaneous coronary intervention via the right radial artery, with the placement of two stents. Two hours after her stay in the Intensive Care Unit, the patient, who was generally stable, began to experience pain and haematoma formation on the volar aspect of the right forearm in relation to the catheter puncture site.
The patient was assessed by the Traumatology Department and the physical findings of the examination were as follows:
- Pain, exacerbated by passive extension of the fingers (extension of the flexor muscles of the forearm).
- Pallor.
- Inability to detect radial or ulnar pulse.
- Decrease in temperature with respect to the contralateral limb.
- Anaesthesia and total paralysis of the affected limb.
In view of the clinical findings, a confirmatory diagnosis was made by measuring intra-compartmental pressure with the Stryker® "Intra-Compartmental pressure monitor system", obtaining a reading of 42mm Hg. The diagnosis of acute compartment syndrome in the right forearm was determined and urgent surgical treatment was proposed.
The surgical procedure was performed under balanced general anaesthesia and airway control with a laryngeal mask. Antibiotic prophylaxis with 2 grams of intravenous Cefazolin. A skin incision was made over the midline of the volar side of the forearm, from the elbow flexure to Kaplan's line. The subcutaneous cellular tissue was intensely infiltrated by haematoma. A longitudinal section of the forearm fascia was performed, exposing the epitrochlear musculature of the forearm, and decompression of the median nerve was performed by section of the carpal annular ligament. No vascular lesions with signs of active arterial bleeding were observed. For surgical closure, the wound was covered with sterile compresses impregnated with Nitrofural, and the wound was closed by means of mesh with vascular elastic vessel loops and a non-compressive bandage.

As soon as the fasciotomy was performed, recovery of the colour and temperature of the affected limb was observed, as well as recovery of the arterial pulse. Three hours after surgery, the patient was re-evaluated, with capillary refill of less than 2 seconds, mobility and distal sensitivity, and no pain. Nine hours later, the patient presented absence of pain in the right forearm, with good distal vasculonervous status.

