QuestionSBA
QuestionChoice
This would be expected in ulnar nerve injury. Supracondylar fractures tend to cause radial nerve injuries which may present with wrist drop and sensory deficits.
10035900
d
Ulnar claw on examination
QuestionChoice
This would certainly be expected in cases of compartment syndrome in the lower limb, however, this child has sustained a supracondylar fracture, a common fracture in the upper limb in children therefore would not impact the lower limb.
10035898
b
Pain on passive flexion of toes
QuestionChoice
This is more in keeping with a fat embolism following a long bone fracture in an orthopaedic context.
10035901
e
Petechial rash on examination
QuestionChoice
This is correct. This is suggestive of a diagnosis of compartment syndrome in the arm. In children, anxiety associated with increasing analgesic requirements, often necessitating opioid medications, is a reliable indicator of compartment syndrome which most commonly occurs following trauma and presents with severe pain, pallor, paraesthesia and in severe cases paralysis.
10035897
a
Excessive use of breakthrough analgesia
QuestionChoice
This may well occur in the late stages of compartment syndrome in the lower limb but the injury here is in the upper limb.
10035899
c
Absence of dorsalis pedis pulse
Concept
Chapter
2693
3903
Compartment syndrome
Topic
145
Orthopaedics
19583
Anxiety and increased analgesic requirements in a child after limb trauma may indicate compartment syndrome.
A 7-year-old boy is brought to the emergency department following a road traffic accident with a traumatic supracondylar fracture. The fracture is reduced and a cast is placed. A few hours later he appears anxious and in pain. Examination demonstrates pallor and paraesthesia.

Which of the following is most likely to be observed in this patient?
a