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Compartment Syndrome in Children With a Supracondylar Fracture: Not Everyone has Risk Factors
Douglas G Armstrong1, Rhett MacNeille2, Erik B Lehman3
1Department of Orthopedics and Rehabilitation, PennState Health Milton S. Hershey Medical Center, Hershey, PA.
Insights
Compartment syndrome (CS) requiring fasciotomy is rare in pediatric supracondylar humerus fractures, occurring in 0.49% of cases. Associated factors include male sex, nerve injury, and forearm fractures, but timing of treatment did not impact outcomes.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Musculoskeletal Conditions
Background:
- Supracondylar (SC) fractures of the humerus are common in children.
- Compartment syndrome (CS) is a serious complication that can arise from these fractures.
- Fasciotomy is a critical surgical intervention for CS.
Purpose of the Study:
- To determine the incidence of fasciotomy for CS in pediatric SC humerus fractures.
- To identify associated conditions with CS in this population.
- To analyze the timing of fasciotomy relative to fracture treatment.
Main Methods:
- Retrospective study of a trauma system database.
- Inclusion of children aged 2-13 years with SC humerus fractures (January 2001 - December 2015).
- Analysis of demographic data, associated injuries, and treatment details.
Main Results:
- Fasciotomy was performed in 0.49% of pediatric SC humerus fractures.
- CS/fasciotomy was more common in males, those with nerve injury, and ipsilateral forearm fractures.
- Vascular procedures and forearm fracture fixation were associated with CS; timing of SC fracture treatment did not affect outcomes.
Conclusions:
- While risk factors for CS exist, they are not always present.
- CS can develop after admission or treatment of the SC fracture.
- Current practices for operative management and hospitalization timing are supported by these findings.
Objectives:
To clarify the incidence, associated conditions, and timing of fasciotomy for compartment syndrome (CS) in children with a supracondylar (SC) fracture of the humerus.
Design:
A retrospective trauma system database study.
Setting:
Accredited trauma centers in Pennsylvania.
Patients:
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.
Intervention:
Treatment of a SC fracture.
Main Outcome Measurement:
Diagnosis of CS/performance of a fasciotomy.
Results:
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).
Conclusions:
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.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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