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Pediatric Acute Compartment Syndrome in Long Bone Fractures: Who is at Risk?
Sai Krishna Bhogadi1, Khaled El-Qawaqzeh1, Christina Colosimo1
1Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Insights
Pediatric acute compartment syndrome (ACS) risk factors include increasing age, male gender, and specific fracture types. Delays in operative fixation for extremity fractures significantly increase the odds of developing ACS in children.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Musculoskeletal Disorders
Background:
- Limited large-scale data exists on pediatric acute compartment syndrome (ACS) predictors.
- Literature on operative fixation timing and ACS risk is conflicting.
- This study aimed to identify factors associated with pediatric ACS.
Purpose of the Study:
- To identify predictors of pediatric acute compartment syndrome (ACS).
- To analyze the relationship between operative fixation timing and ACS risk in pediatric extremity fractures.
Main Methods:
- Analysis of the 2017-2019 Trauma Quality Improvement Program database.
- Inclusion of pediatric patients (<18 years) with upper and lower extremity fractures.
- Multivariable regression analyses to determine ACS predictors.
Main Results:
- Lower extremity (LE) fractures had a 0.5% ACS rate; upper extremity (UE) fractures had a 0.16% ACS rate.
- Predictors included older age, male gender, severe injury mechanisms, comminuted/open fractures, and operative fixation.
- Each hour delay in operative fixation increased adjusted odds of ACS by 0.4% (P < 0.05).
Conclusions:
- Findings can help clinicians identify children at risk for ACS.
- Further research is needed on optimal operative fixation timing for pediatric long bone fractures to mitigate ACS risk.
Introduction:
There is a paucity of large-scale data on the factors that suggest an impending or underlying extremity pediatric acute compartment syndrome (ACS). In addition, literature regarding the timing of operative fixation and the risk of ACS is mixed. We aimed to describe the factors associated with pediatric ACS.
Methods:
Analysis of 2017-2019 Trauma Quality Improvement Program. We included patients aged <18 y diagnosed with upper extremity (UE) and lower extremity (LE) fractures. Burns and insect bites/stings were excluded. Multivariable regression analyses were performed to identify the predictors of ACS.
Results:
61,537 had LE fractures, of which 0.5% developed ACS. 76,216 had UE fractures, of which 0.16% developed ACS. Multivariable regression analyses identified increasing age, male gender, motorcycle collision, and pedestrian struck mechanisms of injury, comminuted and open fractures, tibial and concurrent tibial and fibular fractures, forearm fractures, and operative fixation as predictors of ACS (P value <0.05). Among LE fractures, 34% underwent open reduction internal fixation (time to operation = 14 [8-20] hours), and 2.1% underwent ExFix (time to operation = 9 [4-17] hours). Among UE fractures, 54% underwent open reduction internal fixation (time to operation = 11 [6-16] hours), and 1.9% underwent ExFix (time to operation = 9 [4-14] hours). Every hour delay in operative fixation of UE and LE fractures was associated with a 0.4% increase in the adjusted odds of ACS (P value <0.05).
Conclusions:
Our results may aid clinicians in recognizing children who are "at risk" for ACS. Future studies are warranted to explore the optimal timing for the operative fixation of long bone fractures to minimize the risk of pediatric ACS.
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