Mini approaches fasciotomy combined with vacuum sealing drainage for acute compartment syndrome caused by fractures in children.

Abstract

Acute compartment syndrome (ACS) is an urgent, critical condition that requires immediate fasciotomy once diagnosed. Traditionally, fasciotomy of the forearms and lower leg involves one or two long approaches. Our previous study demonstrated that mini approaches fasciotomy was an effective method to treat ACS. This study is aimed at further evaluating the limb functions and complications of mini approaches combined with vacuum sealing drainage (VSD) for treating ACS caused by fractures in the forearms and lower legs. This was a retrospective cross-sectional study, and after applying the inclusion and exclusion criteria, we reviewed 126 children who underwent mini treatment approaches for ACS from Jan 2008 to Jan 2022. The selected patients were divided into two groups: group A (ACS group; 58 patients aged 7.77±3.45 years) and group B (ACS combined with VSD; 68 patients aged 7.17±3.55 years). Patients' clinical data were collected. The patients were followed up, and muscle function in the forearms and lower legs was evaluated. The overall incidence of lower legs and forearmsACS was 126/29642 (0.425%). The most common mechanisms of injury were fractures of the forearm (39/74, 52.7%), supracondylar humerus (31/74 41.9%), and elbow (4/74, 5.4%), while those for the lower legs were fractures of the proximal tibia (19/52, 36.5%), midshaft of tibia (25/52, 48.1%), and distal tibia (7/52, 13.5%). According to Flynn's assessment, no significant difference was observed between the two groups (p=0.151). However, the two groups showed significant differences in the hospitalization time (p=0.002) and incision infection rate (0.043). Mini approaches fasciotomy combined with VSD is an effective and safe method to treat ACS of the forearms and lower legs caused by fractures in children. This method involves a single-stage surgery and is associated with shorter hospitalization time and incision infection.