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Upper extremity pediatric compartment syndromes
1Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Compartment syndrome in children often results from fractures. Early recognition of risk factors and prompt fasciotomy are crucial for preventing limb damage, especially in agitated children with increasing pain.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Compartment syndrome is a serious complication of fractures in children.
- Soft-tissue injuries associated with fractures increase risk.
- Delayed diagnosis can lead to devastating outcomes.
Purpose of the Study:
- To highlight the importance of recognizing fractures that risk compartment syndrome in children.
- To emphasize early diagnosis and treatment of compartment syndrome.
- To alert clinicians to subtle signs in pediatric patients.
Main Methods:
- Review of pediatric fracture cases associated with compartment syndrome.
- Analysis of risk factors and fracture patterns.
- Evaluation of treatment outcomes for fasciotomy and fracture fixation.
Main Results:
- Fractures are the primary cause of compartment syndrome in pediatric limbs.
- Specific fractures and soft-tissue injuries elevate risk.
- Percutaneous pinning or intramedullary fixation is superior to casting for high-risk limbs.
Conclusions:
- Vigilance for compartment syndrome in pediatric fractures is critical.
- Unexplained pain escalation or behavioral changes in children require thorough evaluation.
- Avoiding misattribution of symptoms to age or fracture pain prevents missed diagnoses and poor outcomes.
Abstract:
Fractures are associated with the majority of compartment syndromes in children. Respect for associated soft-tissue injuries and recognition of specific fractures that can put a limb at risk for compartment syndrome are essential for prevention or successful treatment with early decompressive fasciotomies. In those limbs at risk for compartment syndrome, percutaneous pinning or intramedullary fixation provides fracture stabilization and prevents problems noted with standard cast treatment. Any condition that causes increased tissue pressure within a limited space can lead to compartment syndrome, however. It therefore is important to identify the injured, ill, or hospitalized child with unexplained changes in pain status or soft tissues. In particular, the agitated child with increasing analgesia requirements requires a thorough evaluation. The child's behavior should not be attributed to young age, fear, or fracture pain. This is a trap that must be avoided to prevent the disastrous outcomes of a missed compartment syndrome.