Compartment Syndrome In Children Research Articles

Abdominal Compartment Syndrome in Children: Perioperative Concerns and Considerations ACS in Children

Abdominal Compartment Syndrome in Children: Perioperative Concerns and Considerations ACS in Children

Compartment Syndrome in Children With a Supracondylar Fracture: Not Everyone has Risk Factors.

To clarify the incidence, associated conditions, and timing of fasciotomy for compartment syndrome (CS) in children with a supracondylar (SC) fracture of the humerus. A retrospective trauma system database study. Accredited trauma centers in Pennsylvania. A statewide trauma database was searched for children 2-13 years of age admitted with a SC fracture between January 2001 and December 2015. Four thousand three hundred eight children met inclusion criteria. Treatment of a SC fracture. Diagnosis of CS/performance of a fasciotomy. During the study period, 21 (0.49%) children admitted with a SC fracture of the humerus were treated with fasciotomy. CS/fasciotomy was more likely in males (P = 0.031), those with a nerve injury (P = 0.049), and/or ipsilateral forearm fracture (P < 0.001). Vascular procedure, performed in 18 (0.42%) children, was strongly associated with CS/fasciotomy (P < 0.001). Closed reduction and fixation of a forearm fracture was associated with CS (P = 0.007). Timing of SC fracture treatment did not influence outcome. Fasciotomy was performed subsequent to reduction in 13 subjects; mean interval between procedures was 23.4 hours (r = 4.5-51.3). Risk factors for CS exist; however, they are not required for the condition to develop. CS may develop subsequent to admission and/or SC fracture treatment. In timing of operative management and hospitalization, the results support contemporary practice. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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...

Fasciotomy through multiple small skin incisions for the treatment of early acute osteofascial compartment syndrome in children

BackgroundThe purpose of the present study is to investigate the therapeutic effect of fasciotomy through multiple small skin incisions for the treatment of early osteofascial compartment syndrome in children.MethodsFrom January 2009 to May 2017, 56 pediatric patients with early osteofascial compartment syndrome in their limbs were admitted into our department and treated with multiple small skin incisions for decompression at the early stage. The skin incisions, function, and sensation of the limbs were followed up.ResultsThe osteofascial compartment syndrome was diagnosed at 7.4 ± 2.1 h after injury, and then fasciotomy was performed at 1.4 ± 0.4 h later. The average procedure time of fasciotomy was 12.7 ± 4.8 min. No postoperative incision infections or neurovascular injuries were observed in all the patients. The incisions completely healed in 7–10 days with an average healing time of 8 days without secondary suture. The patients were followed up for an average of 5.1 years. No Volkmann’s contractures in the injured limbs were found. The appearance, electromyography, and nerve conduction velocity of the affected limbs were not significantly different from that of the contralateral limbs. All the patients were free of symptoms and were fully recovered of sensation and function, being an “excellent” outcome at the latest follow-up.ConclusionFasciotomy through multiple small skin incisions, which can be useful to decompress the compartment pressure with fewer complications, is a simple and effective strategy for the treatment of early osteofascial compartment syndrome in children.

Impending hand compartment syndrome in an infant: is clinical evaluation enough to perform a fasciotomy?

The purpose of this case report is to raise awareness of the early diagnosis and treatment of compartment syndrome in children. Late diagnosis can lead to irreversible outcomes, including myonecrosis, neurologic injury, functional problems, and even amputation. In this age group, clinical judgment may be enough to proceed with fasciotomy.

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.

Incidence, Risk Factors, and Timing of Compartment Syndrome in Pediatric Patients with Supracondylar Fractures of the Humerus

Purpose: Compartment Syndrome (CS) is one of the most feared consequences of supracondylar fracture of the humerus in children. The exact incidence, the factors contributing to its development and the time of onset subsequent to injury remain unclear. The purpose of this study was to determine: 1) the incidence of compartment syndrome in children with supracondylar fractures of the elbow, 2) when the diagnosis of CS was made, and 3) identify associated …

Abdominal Compartment Syndrome in Children: Clinical and Imaging Features.

The objective of our study was to identify the clinical features and imaging findings of abdominal compartment syndrome (ACS) in children. During the study period, ACS was diagnosed in 50 children, 14 of whom underwent CT or MRI. We reviewed the medical records of the 50 children to obtain clinical information, such as underlying risk factors, therapeutic approach, and clinical outcome, and we evaluated the CT and MRI examinations of the 14 children. We compared the imaging features of the 14 children with ACS with those of 14 age-matched control subjects who had abdominal distention without ACS. The most common risk factor of pediatric ACS was increased abdominal contents, particularly bowel dilatation. Among the 50 children, 38 underwent decompressive intervention. The mortality rate was 45% in the group who underwent decompression versus 58% in the group who did not undergo decompression intervention. From a review of the CT and MR images of the 14 patients with these examinations, we found that the most common findings were ascites (86%), basal lung atelectasis (69%), inferior vena cava (IVC) compression (50%), and abnormal enhancement of bowel wall (64%). Compared with the control subjects, the study group with ACS had the following suggestive imaging features: IVC compression (p = 0.001), basal lung atelectasis (p = 0.006), heterogeneous perfusion of the kidneys (p = 0.026), ascites (p = 0.043), and subcutaneous edema (p = 0.053). However, the ratio of maximal anteroposterior-to-transverse abdominal diameter (AT ratio) was not significant (p = 0.565). A well-known CT finding for ACS, an increased AT ratio, proved not specific for ACS in pediatric patients; rather, IVC compression, basal lung atelectasis, compromised renal perfusion, and ascites should raise suspicion for ACS in children.

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

An update on intra-abdominal hypertension and abdominal compartment syndrome in children

The concept of intra-abdominal hypertension and abdominal compartment syndrome is relatively new, but increasing awareness and evolving management strategies have been instrumental in reducing mortality by nearly half in critically ill patients with this condition. The thresholds for intraabdominal hypertension and abdominal compartment syndrome in children are different from adults. When intraabdominal pressure increases, it affects both abdominal and extra-abdominal organs. This needs to be recognised, the vicious cycle of poor perfusion and increasing intraabdominal pressure which ultimately leads to ischemic cellular necrosis. Focus has gradually shifted from treatment to prevention of progress of intraabdominal hypertension. Various non invasive methods can be used effectively to decrease intra-abdominal pressure, but surgical decompression is essential when organ dysfunction and abdominal compartment syndrome set in. This review describes the definitions, risk factors, pathophysiology and management strategies for increased intra-abdominal pressure in children.

Fulminant Pseudomembranous Colitis and Abdominal Compartment Syndrome

Patients with cystic fibrosis have higher rates of Clostridium difficile colonization than the general population. However, complicated forms of presentation are rare. We present a case of pseudomembranous fulminant pancolitis with abdominal compartment syndrome in a 9-year-old boy with cystic fibrosis. Conclusion: The incidence of Clostridium difficile infection is higher in patients with cystic fibrosis. Although it is rare, fulminant colitis can be associated with abdominal compartment syndrome. This is the only reported case of fulminant Clostridium difficile colitis associated with abdominal compartment syndrome in children who survived without total colectomy.

The limping child.

Limping is a symptom of varied diagnoses in children and adolescents and can present a difficult diagnostic challenge for primary care clinicians. A careful and systematic evaluation can shorten the long list of potential diagnoses to direct appropriate diagnostic tests to determine the cause of the problem. Trauma and infections are the most common causes of limping. Inflammatory conditions, developmental diagnoses,and overuse injuries are other causes. Although rare, malignancies such as osteosarcoma and blood cell cancers must also be considered as potential causes of limping in children and adolescents.• Limping presents a diagnostic challenge due to the number of possible causes.• On the basis of consensus, diagnostic laboratory tests that include complete blood count, erythrocyte sedimentation rate,C-reactive protein, and blood cultures should be ordered if suspicion is high for infectious etiology.• On the basis of consensus, orthopedic emergencies are vascular compromise, compartment syndrome, and open fractures.• On the basis of moderate evidence and consensus, compartment syndrome in children presents with the three "As" analgesia,anxiety, and agitation. (4)• On the basis of strong evidence and consensus, septic arthritis asa diagnosis increases with the number of Kocher criteria present(temperature >38.5°C, white blood cell count >12,000/mL[12109/L], erythrocyte sedimentation rate >40 mm/h, and inability to bear weight). (8)• On the basis of moderate evidence and consensus, laboratory studies are not always definitive for diagnosis of juvenile idiopathic arthritis. (13)• On the basis of consensus, it is always important to examine the joint above and the joint below the area of the chief compliant,specifically when looking at slipped capital femoral epiphysis and Legg-Calvé-Perthes disease.

Diagnosis and Treatment of Acute Compartment Syndrome in Children

Diagnosis and Treatment of Acute Compartment Syndrome in Children

Incidence and prognosis of intraabdominal hypertension and abdominal compartment syndrome in children

PurposeIntraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high mortality rates in children (40–60%). However, literature lacks comprehensive series in childhood. In this study, we aimed to determine the incidences of IAH and ACS, to identify high risk disorders for the development of IAH/ACS and to decrease ACS-associated mortality by early diagnosis and timely intervention. MethodsA prospective study was performed between December 2009 and October 2010 in our institution. IAH was defined by a sustained or repeated pathological elevation in IAP≥12mmHg without a new organ failure. ACS was identified as a sustained IAP>15mmHg with a new organ dysfunction/failure. After recognition of IAH or ACS, patients underwent prompt decompressive interventions as medical or surgical procedures. Results150 patients were enrolled to the study (86 M, 64 F). The incidences of IAH and ACS were 9% and 4%, respectively. High risk disorders were trauma, ileus, necrotizing enterocolitis, abdominal wall defects, diaphragmatic hernia and septic shock with massive fluid resuscitation. 14 patients with IAH were treated and mean IAP was decreased from 13.9±1.9mmHg to 9.2±2.1mmHg (p<0.001). None of them progressed to ACS. Six patients with ACS underwent decompressive laparotomy. Mean IAP decreased significantly from 20±3mmHg to 9±1.4mmHg (p=0.001). Vital signs like mean urine output, abdominal perfusion pressure (APP) and respiratory rate were significantly improved after surgery (p<0.05). ACS-associated mortality rate was determined as 16%. ConclusionsIAH or ACS was occurred in nearly one tenth of patients admitted to neonatal and pediatric intensive care units. High clinical suspect must be drawn on to recognize and treat these clinical complications more efficiently. Regular and frequent IAP measurement in high risk disorders is essential for early diagnosis. Lower mortality rates can be achieved by early recognition and timely intervention in children.

Interpretation of the international guidelines for definition and clinical management of intra-abdominal hypertension and abdominal compartment syndrome in children, 2013

近年来,在重症或外伤患者的救治过程中,腹腔内压力(IAP)的重要性越来越得到重视,对腹腔内高压(IAH)及腹腔间隙综合征(ACS)的研究也逐渐增多.2004年世界腹腔间隙综合征协会(The World Society of the Abdominal Compartment Syndrome,WSACS)成立,其专家委员会在2006年提出关于IAH和ACS定义的共识[1],2007年制定临床治疗指南[2],并在2009年提出研究的建议[3],但无论是诊断还是治疗,都主要是针对成人而言.2011年WSACS的第五次国际会议,在回顾文献、更新2006年及2007年诊治指南的基础上,制定的2013版指南特别将ACS诊断标准及治疗方法中的儿童部分单独列出[4],现将儿童部分的内容及其修订的背景进行解读。

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.

Decompressive laparotomy for abdominal compartment syndrome in children on ECMO: Effect on Support and Survival

PurposeAbdominal compartment syndrome (ACS) may complicate ECMO due to significant fluid shifts resulting in tense ascites and interstitial edema. This compromises venous cannula flow leading to inadequate patient support. It is debatable whether decompressive laparotomy should be performed in these patients due to the risk of bleeding and poor prognosis. We sought to evaluate the effect of decompressive laparotomy on ECMO support and patient survival. MethodsWe reviewed our tertiary care children's hospital ECMO registry (2000–2011) identifying those who underwent decompressive laparotomy. All had ACS as characterized by abdominal hypertension with abdominal distention, hemodynamic instability, oliguria, rising central venous pressures, and inadequate venous return to the ECMO circuit. Physiologic parameters immediately before and 60min after laparotomy were compared using a signed rank test. ResultsSeven patients were identified. ACS developed within 8h of initiating ECMO in 6 patients. Decompressive laparotomy resulted in significant improvement of patient physiologic parameters and ECMO venous return. One patient had significant bleeding following laparotomy. There were no survivors but three were organ donation candidates after stabilization via decompressive laparotomy. ConclusionDecompressive laparotomy for ACS in patients on ECMO markedly improves support and tissue perfusion. While in our series ECMO complicated by ACS carries a poor prognosis, we cannot confidently define this as futile therapy due to the limited sample size.

Abdominal Compartment Syndrome in Children

Abdominal compartment syndrome is defined as sustained intra-abdominal pressure greater than 20 mm Hg (with or without abdominal perfusion pressure <60 mm Hg) associated with new organ failure or dysfunction. The syndrome is associated with 90% to 100% mortality if not recognized and treated in a timely manner. Nurses are responsible for accurately measuring intra-abdominal pressure in children with abdominal compartment syndrome and for alerting physicians about important changes. This article provides relevant definitions, outlines risk factors for abdominal compartment syndrome developing in children, and discusses an instructive case involving an adolescent with abdominal compartment syndrome. Techniques for measuring intra-abdominal pressure, normal ranges, and the importance of monitoring in the critical care setting for timely identification of intra-abdominal hypertension and abdominal compartment syndrome also are discussed.

Children’s orthopaedics

The October 2012 Children’s orthopaedics Roundup360 looks at: magnetic growing rods and scoliosis correction; maintaining alignment after manipulation of a radial shaft fracture; Glaswegian children and swellings of obscure origin; long-term outcome of femoral derotation osteotomy in cerebral palsy; lower-leg fractures and compartment syndrome in children; fractures of the radial neck in children; management of the paediatric Monteggia fracture; and missing the dislocated hip in Western Australia.

Acute Traumatic Compartment Syndrome of the Leg in Children: Diagnosis and Outcome

Currently, the most common clinical scenario for compartment syndrome in children is acute traumatic compartment syndrome of the leg. We studied the cause, diagnosis, treatment, and outcome of acute traumatic compartment syndrome of the leg in children. Forty-three cases of acute traumatic compartment syndrome of the leg in forty-two skeletally immature patients were collected from two large pediatric trauma centers over a seventeen-year period. All children with acute traumatic compartment syndrome underwent fasciotomy. The mechanism of injury, date and time of injury, time to diagnosis, compartment pressures, time to fasciotomy, and outcome at the time of the latest follow-up were recorded. Thirty-five (83%) of the forty-two patients were injured in a motor-vehicle accident and sustained tibial and fibular fractures. The average time from injury to fasciotomy was 20.5 hours (range, 3.9 to 118 hours). In general, the functional outcome was excellent at the time of the latest follow-up. No cases of infection were noted when fasciotomy was performed long after the injury. At the time of the latest follow-up, forty-one (95%) of forty-three cases were associated with no sequelae (such as pain, loss of function, or decreased sensation). The two patients who lost function had fasciotomy 82.5 and eighty-six hours after the injury. Despite a long period from injury to fasciotomy, most children who are managed for acute traumatic compartment syndrome of the leg have an excellent outcome. This delay may occur because acute traumatic compartment syndrome manifests itself more slowly in children or because the diagnosis is harder to establish in this age group. The results of the present study should raise awareness of late presentation and the importance of vigilance for developing compartment syndrome in the early days after injury. Fasciotomy during the acute swelling phase, even long after injury, produced excellent results with no cases of infection.