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Published on: May 31, 2019
Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome
D S Bae1, R K Kadiyala, P M Waters
1The Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Diagnosing pediatric compartment syndrome is challenging. An increased need for pain medication, alongside other signs, is a key indicator for early intervention and successful recovery in children.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Pediatric Emergency Medicine
Background:
- Compartment syndrome in children presents diagnostic challenges.
- Delayed diagnosis can lead to severe, irreversible complications.
- Fractures are a common cause of pediatric compartment syndrome.
Purpose of the Study:
- To review cases of pediatric compartment syndrome.
- To identify reliable diagnostic indicators in children.
- To evaluate treatment outcomes and functional recovery.
Main Methods:
- Retrospective review of 36 cases in 33 pediatric patients (1992-1997).
- Analysis of clinical signs, symptoms, and treatment interventions.
- Correlation of diagnostic indicators with patient outcomes.
Main Results:
- Most cases (75%) occurred with fractures.
- Classic signs (pain, pallor, etc.) were unreliable.
- Increased analgesia requirement was a sensitive indicator.
- Early diagnosis and treatment led to >90% functional recovery.
Conclusions:
- Early recognition of compartment syndrome in children is crucial.
- Increased analgesia requirement is a vital diagnostic clue.
- Prompt intervention ensures a high rate of functional restoration.
Abstract:
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.
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