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The upper hand on compartment syndrome.Dolan, Roisin T; Al Khudairy, Ammar; Mc Kenna, Paul; Butler, Joseph S; O'Beirne, Joseph; Quinlan, John F; Department of Trauma & Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland. email@example.com (2012-11)Metacarpal fractures are common injuries, accounting for approximately 30% to 40% of all hand fractures and with a lifetime incidence of 2.5%. Traditionally regarded as an innocuous injury, metacarpal fractures tend to be associated with successful outcomes after closed reduction and immobilization. Hand compartment syndrome (HCS) is a rare clinical entity with potential devastating consequences in terms of loss of function and quality-of-life outcomes. We discuss the case of a 44-year-old woman presenting with multiple closed metacarpal fractures as a result of low-energy trauma, complicated by acute HCS. We review the presentation, clinical assessment, and optimal surgical management of acute HCS with reference to international literature.