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Forearm Compartment Pressure Change in Children Operated for Supracondylar Humerus Fracture
Soner Toğaç1, Gökay Eken2, Cenk Ermutlu2
1Department of Orthopedics and Traumatology, Manisa Merkezefendi State Hospital, Manisa.
Insights
Forearm compartment pressures increase after surgery for Gartland type III humerus fractures, particularly with open reduction. Pressures gradually decrease postoperatively, but prolonged surgery or delayed fixation correlates with higher values.
Area of Science:
- Orthopedic surgery
- Pediatric trauma
- Compartment syndrome
Background:
- Gartland type III extension type supracondylar humerus fractures require operative intervention.
- Understanding forearm compartment pressure dynamics is crucial for managing these injuries.
Purpose of the Study:
- To analyze preoperative and postoperative forearm compartment pressures in patients with Gartland type III humerus fractures.
- To investigate the trend of these pressures during the early postoperative period.
Main Methods:
- Prospective study of 31 pediatric patients undergoing surgical repair.
- Forearm compartment pressures measured preoperatively and at 4-hour intervals for 24 hours postoperatively using a catheter.
- Evaluation of reduction technique (open vs. closed), surgery duration, and time from injury to surgery.
Main Results:
- Immediate postoperative compartment pressures significantly increased in all patients, gradually decreasing over 24 hours.
- Open reduction was associated with higher mean compartment pressures at 12 hours postoperatively compared to closed reduction.
- Preoperative compartment pressures were higher in patients with delayed surgery (>12 hours).
- Prolonged operative time (>1 hour) correlated with significantly higher postoperative compartment pressures at 0, 12, and 20 hours.
Conclusions:
- Open reduction for Gartland type III humerus fractures leads to elevated preoperative and postoperative compartment pressures.
- The reduction procedure itself increases compartment pressure, which then subsides postoperatively.
- Delayed surgical fixation and longer operative times are linked to increased compartment pressures.
Background:
The aim of this study is to examine the preoperative and postoperative forearm compartment pressures in patients treated operatively for Gartland type III extension type supracondyler humerus fractures and understand the course of these values over postoperative period.
Methods:
Deep volar compartment pressure of 31 patients were measured in the proximal one third of the forearm preoperatively, and measurements were continued every 4 hours for the first 24 hours after the operation with a catheter. Type of the reduction technique (open reduction vs. closed reduction), duration of surgery, the time from the injury to surgery were all evaluated.
Results:
In the measurements made immediately after the operation (0 h), a sudden increase in the compartment pressure was detected in all patients (15.0±5.9 to 27.9±7.5 mm Hg) independent of the reduction technique and gradually decreased over time. The mean compartment pressure at the 12th hour postoperatively was higher in the open reduction group than in the CR group (24.5±3.4, 20.7±6.7 mm Hg, respectively) ( P =0.044). The mean preoperative compartment pressure was 17.7±5.8 mm Hg in patients with a time from injury to surgery longer than 12 hours, and 12.4±4.8 mm Hg in patients with 12 hours or less ( P =0.006). The postoperative 0-, 12-, and 20-hour pressure values were higher in the >1 hour operation time group than in the ≤1 hour group and the differences were statistically significant ( P =0.046, 0.016, and 0.032, respectively).
Conclusions:
In pediatric supracondylar humeral fractures, those who underwent open reduction had higher preoperative and postoperative compartment pressures. The reduction attempt was found to be a factor that increased the compartment pressure and after the operation, the compartment pressure values decrease gradually. Prolonged operative time (>1 h) and increased time from injury to operative fixation (>12 h) were associated with higher compartment pressures.
Level Of Evidence:
Level II-prospective study.
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