Acute, chronic, and non-fracture-related compartment syndrome in children. A current concepts review.

BACKGROUND: Pediatric acute compartment syndrome (PACS) is a rare limb-threatening emergency. Diagnosis is complicated by pediatric developmental physiology and communication barriers. Although traumatic fractures are the primary cause, non-fracture etiologies present unique diagnostic challenges. This review summarizes the latest evidence on the changing epidemiology, pathophysiology and diagnostic approaches to acute, chronic, and non-fracture compartment syndromes in children. METHODS: A comprehensive literature search was conducted across the PubMed/MEDLINE, Embase, and the Cochrane Library databases. The review included English-language, peer-reviewed articles published between January 1966 and May 2026, utilizing Medical Subject Headings and keywords such as "compartment syndrome," "pediatric," "children," and "fasciotomy". RESULTS: The diagnostic approach to PACS has shifted from the unreliable "5 Ps" at late stages to the early "3 As": increased anxiety, agitation, and analgesic requirements. Children naturally have higher baseline compartment pressures than adults, so pediatric-specific interpretations of pressure monitoring are required. While fracture-related PACS generally has an excellent prognosis if recognised and treated promptly, non-fracture acute compartment syndrome frequently suffers from critical diagnostic delays, leading to high rates of myonecrosis. The definitive standard of care remains an emergent decompressive fasciotomy. However, pediatric tissue demonstrates robust regenerative capacity, enabling conservative initial muscle debridement and achieving high success rates with delayed primary wound closure. CONCLUSIONS: Although pediatric patients have remarkable healing potential, even following delayed surgical interventions, early recognition is essential to preventing permanent disability. The ability to safeguard limbs depends entirely on clinician's ability to prioritize the behavioral "3 As" over late-stage neurovascular changes.