Acute compartment syndrome of the hand after a wasp sting: a case report

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1. J Pediatr Orthop B. 2010 Jan;19(1):82-5.

Acute compartment syndrome of the hand after a wasp sting: a case report.

Sawyer JR, Kellum EL, Creek AT, Wood GW 3rd.

Department of Orthopaedic Surgery, Campbell Clinic-University of Tennessee,
Tennessee 38104, USA. Jsawyer@campbellclinic.com

Compartment syndrome of the hand is an uncommon entity in children and is usually
the result of trauma or burns. Insects, such as wasps, produce a wide variety of 
toxins such as amines, peptides, and enzymes that can cause local and systemic
inflammatory reactions after a sting. This inflammation can, in rare cases, lead 
to the development of a compartment syndrome. We present the case of a 5-year-old
boy who developed a compartment syndrome of the hand after a single wasp sting
that required emergent fasciotomy. To our knowledge, this has not been reported
previously in the literature. An institutional review board approved review of
the case. The clinical presentation, laboratory studies, radiographs, and
possible-exacerbating factors leading to the development of a compartment
syndrome, as well as the surgical procedure and postoperative course, were
reviewed. Preoperative, intraoperative, and postoperative photographs are also
presented. A 5-year-old boy presented to the emergency department 18 h after a
single wasp sting to the dorsum of his hand. Based on his history and physical
examination, hand compartment pressures were measured in his hand and found to be
elevated. He underwent emergent fasciotomies with delayed wound closure. The
patient healed uneventfully and at 5-month follow-up had full use of his hand,
full range of motion, and normal 2-point discrimination in all the fingers. In
conclusion, while wasp and other insect stings are common in children, this case 
is the first, to our knowledge, of a compartment syndrome of the hand after a
wasp sting. Local measures used to treat insect stings such as heat and elevation
may have played a role in the development of a compartment syndrome. It is
important to have a high index of suspicion for this condition in a patient who
presents with signs and symptoms of a compartment syndrome after an insect sting.
Level of evidence: IV.

PMID: 19801954 [PubMed - indexed for MEDLINE]