Risk Factors and Timing of Fasciotomy for Isolated Pediatric Lower Extremity Trauma

Area of Science:

• Trauma Surgery
• Pediatric Orthopedics
• Vascular Surgery

Background:

• Single-center studies suggest delayed fasciotomy in pediatric trauma patients (PTPs) with compartment syndrome.
• This study investigates delayed fasciotomies in isolated pediatric lower extremity trauma (LET).

Purpose of the Study:

• To test the hypothesis that most fasciotomies in isolated pediatric lower extremity trauma are delayed (>6 hours from admission).
• To identify risk factors associated with pediatric fasciotomy.

Main Methods:

• Querying the 2017-2020 TQIP database for PTPs (<17 years) with isolated leg injuries.
• Performing multivariable logistic regression to identify risk factors for fasciotomy.

Main Results:

• 60.3% of fasciotomies were delayed, with a median time of 9.6 hours.
• Independent risk factors for fasciotomy included popliteal vein (OR 30.72), femoral vein (OR 18.19), popliteal artery (OR 13.74) injuries, and tibial fracture (OR 7.46).
• Fasciotomy patients had higher rates of severe LET, in-hospital complications, limb loss, and longer length of stay.

Conclusions:

• The majority of fasciotomies for pediatric lower extremity trauma are delayed.
• Popliteal vein injury is a significant risk factor for fasciotomy in this population.
• Delayed fasciotomy is associated with increased complications and longer hospital stays for pediatric trauma patients.