Distal radius fractures are common in children, yet complications are rare. A rarely described complication, acute volar compartmental syndrome, occurred in a 15-year-old boy. An accurate physical examination and awareness of the syndrome are essential for diagnosis. Compartmental pressures can be obtained easily and afford a rapid means of corroboration. Once the diagnosis is established, adequate decompression of all involved compartments, including carpal tunnel release, is essential. The literature is unclear regarding the etiology of this complication. There is nothing structurally intrinsic to the distal radius that should lead to a compartmental syndrome. Both the amount of soft tissue damage at the time of fracture and the mode of immobilization (excessive elevation, constricting splint, etc.) are the ultimate determinants of a successful (or unsuccessful) outcome.