Acute Compartment Syndrome In Children Research Articles

Acute upper limb compartment syndrome in children: special focus on nerve recovery

BackgroundMany studies have discussed acute compartment syndrome in children associated with or without fractures and have given their visible perspectives. Little is known about the nerve involvement and the factors...

Acute Compartment Syndrome in Children: Don’t Miss This Elusive Diagnosis

Acute compartment syndrome (ACS) is an orthopedic emergency that can have irreparable sequela if not diagnosed and treated promptly. There are, however, numerous challenges to making a timely diagnosis in children. Not only is ACS uncommon in children, but clinical presentations are often atypical, and accurate assessments can be challenging in young patients with developing motor skills and limited language abilities. Practitioners should be alert to the possibility of ACS in any situation that results in musculoskeletal trauma because the syndrome results from increased pressure within an enclosed fascial space. Making a timely and accurate diagnosis is essential to good outcomes.

Early morbidity associated with fasciotomies for acute compartment syndrome in children.

:PurposeAcute compartment syndrome (ACS) requires urgent fasciotomy to decompress the relevant muscle compartment/s prior to onset of irreversible myonecrosis and nerve injury. A fasciotomy is not a benign procedure. This study aims to describe and quantify early morbidity directly associated with fasciotomies for ACS in children.MethodsClinical charts of 104 children who underwent 112 fasciotomies over a 13-year period at a tertiary children’s hospital were reviewed. The following were analyzed: ACS aetiology, fasciotomy site, number of subsequent procedures, method of wound closure, short-term complications and length of hospital stay.ResultsShort-term complications included wound infections (6.7%) and the need for blood transfusion (7.7%). Median number of additional operations for wound closure was two (0 to 10) and median inpatient stay was 12 days (3 to 63; SD 11.7). After three unsuccessful attempts at primary closure, likelihood of needing skin grafting for coverage exceeded 80%. Analyses showed that fasciotomy-wound infections were associated with higher risk for four or more closure procedures. Number of procedures required for wound closure correlated with longer inpatient stay as did ACS associated with non-orthopaedic causes.ConclusionFasciotomy is associated with significant early morbidity, the need for multiple closure operations, and prolonged hospital stay. The decision for fasciotomy needs careful consideration to avoid unnecessary fasciotomies, without increasing the risk of permanent injury from missed or delayed diagnosis. Skin grafting should be considered after three unsuccessful closure attempts. Less invasive tests or continuous monitoring (for high-risk patients) for compartment syndrome may help reduce unnecessary fasciotomies.Level of EvidenceLevel IV, Case series

Evaluation of acute compartment syndrome of extremities in emergency room: a case series of 32 children

The aim of this study was to analyze the clinical signs of diagnosis, treatment and followupof the pediatric population presenting with acute compartment syndrome in theemergency room at an Institutional Level II trauma center. The study is a prospective caseseries. Thirty-two samples were selected from Institutional Trauma Centre, King George’sMedical University, Lucknow, between January 2005 and December 2010. Childrenpresenting with clinically suspected acute compartment syndrome were studied. Thesewere divided into two age related groups: Group A (children < 14 years) comprising of 12children and Group B (14 or > to 18 years) comprised of 20 children. Patients’demographics, diagnosis, treatment, follow-up and complications were analyzed. Acutecompartment syndrome represents a surgical emergency. The clinical signs predict andcorroborate with acute increases in compartment pressure effectively.KEY WORDS: Acute compartment syndrome; Raised compartment pressure; Acutecompartment syndrome in children; Acute compartment syndrome and fasciotomy

Diagnosis and Treatment of Acute Compartment Syndrome in Children

Diagnosis and Treatment of Acute Compartment Syndrome in Children

Acute Compartment Syndrome in Children and Teenagers With Tibial Shaft Fractures

To identify the incidence of acute compartment syndrome (ACS) in children and teenagers with tibial shaft fractures and report associated risk factors. Retrospective Case Control. Level 1 pediatric trauma hospital. Two hundred sixteen tibial shaft fractures in 212 patients (160 males and 52 females; median age, 13 years) over a 5-year period were reviewed. One hundred thirty-two (61%) fractures were treated with closed reduction and casting, 36 with external fixation, 27 with locked intramedullary nails, and 21 with flexible intramedullary nails. ACS was diagnosed clinically or by intracompartment pressure. Multivariable logistic regression analysis tested age, gender, weight, physeal status, mechanism of injury, time to surgery, fracture type, and treatment intervention as possible risk factors for development of ACS. There were 25 (11.6%) cases of ACS. Multivariable predictors of ACS included age of 14 years and older (22/96 = 23% vs. 3/120 = 3%, P < 0.001) and motor vehicle accident (MVA) (13/57 = 23% vs. 12/159 = 8%, P < 0.001). Incidence of ACS was 48% among patients aged 14 years and older, who sustained MVA (12/25). Gender, physeal status, time to surgery, and surgical fixation were not predictive of ACS. This is the largest study in children and teenagers reporting the incidence of ACS from tibial shaft fractures. The incidence of 11.6% is higher than previously reported and much higher in patients older than14 years of age and involved in an MVA. Surgeons should be especially aware and suspicious of this diagnosis in teenagers with tibial shaft fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Acute Compartment Syndrome in Children: Contemporary Diagnosis, Treatment, and Outcome

Acute Compartment Syndrome in Children: Contemporary Diagnosis, Treatment, and Outcome

Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome.

Compartment syndrome can be difficult to diagnose in a child, with delays in diagnosis leading to disastrous outcomes. Thirty-six cases of compartment syndrome in 33 pediatric patients were treated at the authors' institution from January 1, 1992, to December 31, 1997. There were 27 boys and 6 girls, with nearly equal upper and lower extremity involvement. Approximately 75% of these patients developed compartment syndrome in the setting of fracture. Pain, pallor, paresthesia, paralysis, and pulselessness were relatively unreliable signs and symptoms of compartment syndrome in these children. An increasing analgesia requirement in combination with other clinical signs, however, was a more sensitive indicator of compartment syndrome: all 10 patients with access to patient-controlled or nurse-administered analgesia during their initial evaluation demonstrated an increasing requirement for pain medication. With early diagnosis and expeditious treatment, >90% of the patients studied achieved full restoration of function.