Trauma: Compartman Syndrome

ortopedi-16-2-2024-kapak-1

Tülin TÜRKÖZÜa , Baki Volkan ÇETİNb

aVan Yüzüncü Yıl University Faculty of Medicine, Department of Orthopedics and Traumatology, Van, Türkiye
bHarran University Faculty of Medicine, Department of Orthopedics and Traumatology, Şanlıurfa, Türkiye

ABSTRACT
Pediatric acute compartment syndrome is one of the few orthopaedic emergency conditions. The children with supracondylar humerus fracture, forearm fracture and tibia fracture are under high risk and they should be closely monitored. Although, its pathophysiology is the same as in adults, unique aspects of pediatric compartment syndrome involve difficulties in examining and communicating with very young children. The ”5 Ps” meaning pain, pallor, paresthesia, paralysis, and pulselessness are the leading clinical symptoms in adults, but those are not reliable markers of acute compartment syndrome (ACS) in young children. The ”3As” meaning agitation, anxiety and increasing need for analgesics may be the first signs of compartment syndrome in children. Compartment syndrome is a clinical diagnosis and compartment measurements should only be performed in patients who cannot communicate or when the diagnosis is unclear. Early diagnosis and rapid treatment are important to achieve good clinical outcomes, however, decompressive fasciotomy should be considered in all the pediatric ACS cases, even if the time from injury to diagnosis is long.
Keywords: Compartment syndrome; children; injury; forearm; tibia; fracture

Referanslar

  1. Von Volkmann R. The ischemic muscular paralysis and trauma. Zentralblatt fur Chirurgie. 1881;8:801-3.
  2. Flynn JM, Bashyal RK, Yeger-McKeever M, Garner MR, Launay F, Sponseller PD. Acute traumatic compartment syndrome of the leg in children: diagnosis and outcome. J Bone Joint Surg Am. 2011;93(10):937-41. [Crossref]  [PubMed]
  3. Mubarak SJ, Carroll NC. Volkmann's contracture in children: aetiology and prevention. J Bone Joint Surg Br. 1979;61-B(3):285-93. [Crossref]  [PubMed]
  4. Battaglia TC, Armstrong DG, Schwend RM. Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus. J Pediatr Orthop. 2002;22(4):431-9. [Crossref]  [PubMed]
  5. Ramachandran M, Skaggs DL, Crawford HA, Eastwood DM, Lalonde FD, Vitale MG, et al. Delaying treatment of supracondylar fractures in children: has the pendulum swung too far? J Bone Joint Surg Br. 2008;90(9):1228-33. [Crossref]  [PubMed]
  6. Diesselhorst MM, Deck JW, Davey JP. Compartment syndrome of the upper arm after closed reduction and percutaneous pinning of a supracondylar humerus fracture. J Pediatr Orthop. 2014;34(2):e1-4. [Crossref]  [PubMed]
  7. Mai MC, Beck R, Gabriel K, Singh KA. Posterior arm compartment syndrome after a combined supracondylar humeral and capitellar fractures in an adolescent: a case report. J Pediatr Orthop. 2011;31(3):e16-9. [Crossref]  [PubMed]
  8. Grottkau BE, Epps HR, Di Scala C. Compartment syndrome in children and adolescents. J Pediatr Surg. 2005;40(4):678-82. [Crossref]  [PubMed]
  9. Yuan PS, Pring ME, Gaynor TP, Mubarak SJ, Newton PO. Compartment syndrome following intramedullary fixation of pediatric forearm fractures. J Pediatr Orthop. 2004;24(4):370-5. [Crossref]  [PubMed]
  10. Blackman AJ, Wall LB, Keeler KA, Schoenecker PL, Luhmann SJ, O'Donnell JC, et al. Acute compartment syndrome after intramedullary nailing of isolated radius and ulna fractures in children. J Pediatr Orthop. 2014;34(1):50-4. [Crossref]  [PubMed]
  11. Flynn JM, Jones KJ, Garner MR, Goebel J. Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 2010;30(4):313-9. [Crossref]  [PubMed]
  12. Blakemore LC, Cooperman DR, Thompson GH, Wathey C, Ballock RT. Compartment syndrome in ipsilateral humerus and forearm fractures in children. Clin Orthop Relat Res. 2000;(376):32-8. [Crossref]  [PubMed]
  13. Ring D, Waters PM, Hotchkiss RN, Kasser JR. Pediatric floating elbow. J Pediatr Orthop. 2001;21(4):456-9. [Crossref]  [PubMed]
  14. Muchow RD, Riccio AI, Garg S, Ho CA, Wimberly RL. Neurological and vascular injury associated with supracondylar humerus fractures and ipsilateral forearm fractures in children. J Pediatr Orthop. 2015;35(2):121-5. [Crossref]  [PubMed]
  15. Hak DJ. Acute compartment syndrome in children. In: Mauffrey C, Hak DJ, Martin III MP, eds. Compartment syndrome: a guide to diagnosis and management. Springer, Cham; 2019. p.125-32. [Crossref]  [PubMed]
  16. Shore BJ, Glotzbecker MP, Zurakowski D, Gelbard E, Hedequist DJ, Matheney TH. Acute compartment syndrome in children and teenagers with tibial shaft fractures: incidence and multivariable risk factors. J Orthop Trauma. 2013;27(11):616-21. [Crossref]  [PubMed]
  17. Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop. 2012;32(8):749-59. [Crossref]  [PubMed]
  18. Mubarak SJ. Extensor retinaculum syndrome of the ankle after injury to the distal tibial physis. J Bone Joint Surg Br. 2002;84(1):11-4. [Crossref]  [PubMed]
  19. Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop. 2001;21(5):680-8. [Crossref]  [PubMed]
  20. Noonan KJ, McCarthy JJ. Compartment syndromes in the pediatric patient. J Pediatr Orthopaed. 2010;30:S96-S101. [Crossref]
  21. Staudt JM, Smeulders MJ, van der Horst CM. Normal compartment pressures of the lower leg in children. J Bone Joint Surg Br. 2008;90(2):215-9. [Crossref]  [PubMed]
  22. Heckman MM, Whitesides TE Jr, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Joint Surg Am. 1994;76(9):1285-92. [Crossref]  [PubMed]
  23. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. 1996;78(1):99-104. [Crossref]  [PubMed]
  24. Royle SG. The role of tissue pressure recording in forearm fractures in children. Injury. 1992;23(8):549-52. [Crossref]  [PubMed]
  25. Shuler MS, Reisman WM, Kinsey TL, Whitesides TE Jr, Hammerberg EM, Davila MG, et al. Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg. J Bone Joint Surg Am. 2010;92(4):863-70. [Crossref]  [PubMed]
  26. Yang CC, Chang DS, Webb LX. Vacuum-assisted closure for fasciotomy wounds following compartment syndrome of the leg. J Surg Orthop Adv. 2006;15(1):19-23.
  27. Broom A, Schur MD, Arkader A, Flynn J, Gornitzky A, Choi PD. Compartment syndrome in infants and toddlers. J Child Orthop. 2016;10(5):453-60. [Crossref]  [PubMed]  [PMC]
  28. Lin JS, Samora JB. Pediatric acute compartment syndrome: a systematic review and meta-analysis. J Pediatr Orthop B. 2020;29(1):90-6. [Crossref]  [PubMed]
  29. Lin J, Samora WP, Samora JB. Acute compartment syndrome in pediatric patients: a case series. J Pediatr Orthop B. 2022;31(2):e236-e40. [Crossref]  [PubMed]
  30. Choi PD, Rose RK, Kay RM, Skaggs DL. Compartment syndrome of the thigh in an infant: a case report. J Orthop Trauma. 2007;21(8):587-90. [Crossref]  [PubMed]