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Compartment syndrome in ipsilateral humerus and forearm fractures in children
L C Blakemore1, D R Cooperman, G H Thompson
1Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Insights
Children with ipsilateral humerus and forearm fractures face a significant risk of compartment syndrome, especially with displaced fractures. Close monitoring is crucial for early detection and intervention.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Ipsilateral humerus and forearm fractures are rare pediatric injuries.
- The association between these fractures and compartment syndrome is not well-established.
Purpose of the Study:
- To determine the incidence of compartment syndrome in children with ipsilateral humerus and forearm fractures.
- To identify specific fracture patterns associated with a higher risk of compartment syndrome.
Main Methods:
- Retrospective review of 978 pediatric upper extremity long bone fractures over 13 years.
- Identification of 43 children with ipsilateral humerus and forearm fractures.
- Analysis of fracture types and development of compartment syndrome.
Main Results:
- Three of 33 children (7%) with supracondylar humerus and forearm fractures developed compartment syndrome.
- All three cases occurred in nine children with displaced extension supracondylar humerus and displaced forearm fractures (33% incidence).
Conclusions:
- Displaced extension supracondylar humerus and displaced forearm fractures in children pose a significant risk for compartment syndrome.
- Perioperative vigilance for compartment syndrome is essential in these high-risk pediatric patients.
Abstract:
Ipsilateral fractures of the humerus and forearm are uncommon injuries in children. The incidence of compartment syndrome in association with these fractures is controversial. The authors reviewed 978 consecutive children admitted to the hospital with upper extremity long bone fractures during a 13-year period. Forty-three children with ipsilateral fractures of the humerus and forearm were identified. Of 33 children with a supracondylar humerus fracture and ipsilateral forearm fracture, three children (7%) had compartment syndrome develop and required forearm fasciotomies. All three cases of compartment syndrome occurred among nine children with ipsilateral displaced extension supracondylar humerus and displaced forearm fractures; the incidence of compartment syndrome was 33% in this group. These findings suggest that children who sustain a displaced extension supracondylar humerus fracture and displaced forearm fracture are at significant risk for compartment syndrome. These children should be monitored closely during the perioperative period for signs and symptoms of increasing intracompartmental pressures in the forearm.