Acute compartment syndrome is a condition in which interstitial tissue pressure within a closed osteo-fascial compartment is elevated to a nonphysiologic level causing decrease in tissue perfusion, which if left elevated for sufficient time, can lead to tissue necrosis and devastating loss of function. It poses a diagnostic and therapeutic challenge for treating surgeons. We present a case of acute post-traumatic bilateral forearm and hand compartment syndrome in a 12 year old boy associated with fracture of distal ulna and metacarpals. Patient regained excellent function with emergent fasciotomy of volar forearm and hand followed by wound management with vacuum-assisted wound closure system (VAC), delayed primary closure and split-thickness skin graft (SSG). Early diagnosis and emergent fasciotomy are crucial to avoid debilitating complications
