Compartment Syndrome in Operatively Managed Pediatric Monteggia Fractures and Equivalents

Area of Science:

• Pediatric Orthopedics
• Trauma Surgery
• Pediatric Surgery

Background:

• Acute compartment syndrome (ACS) is infrequently associated with pediatric Monteggia fractures or equivalents (MF/ME).
• This study investigates the incidence of ACS in operatively managed pediatric MF/ME.
• It compares this incidence to Type 3 supracondylar humerus (T3-SCH) fractures.

Purpose of the Study:

• To determine the rate of ACS in pediatric MF/ME treated surgically.
• To compare the ACS rate in MF/ME to T3-SCH fractures.
• To identify risk factors for ACS development in pediatric MF/ME patients.

Main Methods:

• Retrospective case-control study of children (ages 2-12) with operatively managed MF/ME and T3-SCH fractures over 14 years.
• Fractures classified using Bado criteria for Monteggia injuries.
• Data analyzed for demographic, procedural, and radiographic variables to compare ACS rates and identify risk factors.

Main Results:

• The ACS rate in MF/ME was 15.3% (9/59), significantly higher than 0.9% (2/230) in T3-SCH fractures (P=0.001).
• No differences in ACS rates were found based on sex, Bado Type, or fracture type (MF vs. ME).
• Preoperative vascular deficits (22.2%) and intramedullary radial fixation (P=0.015) were associated with higher ACS rates; neurological deficits showed a trend (P=0.064).

Conclusions:

• Operatively managed pediatric MF/ME demonstrate a significantly higher incidence of ACS compared to T3-SCH fractures.
• All operatively managed MF/ME should be considered at risk for ACS, irrespective of classification.
• Close monitoring for ACS is crucial in patients with preoperative neurovascular deficits and those undergoing intramedullary radial fixation.