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Kamaci S, Yilmaz ET, Tuncay O, Kolac UC, Huri G, Caglar O, Tokgozoglu AM. "Infection rates and complications following fasciotomy in mass casualty events: Lessons learned from the 2023 Turkey-Syria earthquake". Injury 2025; 56:112338. [PMID: 40267857 DOI: 10.1016/j.injury.2025.112338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/01/2025] [Accepted: 04/08/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND This study aimed to investigate the outcomes of fasciotomy, including infection, amputation, and complications, in patients with crush injuries from the 2023 Turkey-Syria earthquake. MATERIAL AND METHODS Out of 210 patients presenting from the earthquake zone, 46 patients (23 male-23 female, mean age: 21 years) who underwent 52 extremity fasciotomies were included. Data collected included infection rates, need for grafts/flaps, amputation rates, creatinine, CK levels, need for dialysis, and neurologic injuries. Early fasciotomy was defined as ≤12 h and late as >12 h after the earthquake. Patients were categorized by fasciotomy timing and location (earthquake-zone or university hospital). Time to first debridement was also evaluated. RESULTS The median time to fasciotomy was 24 h (2-97 h, (IQR 12.5-65)). Fasciotomies performed in the earthquake zone had a higher infection rate (68 % vs. 25 %, p = 0.061), though this difference was not statistically significant, likely due to the small sample size. There was no significant difference in infection rates between patients who underwent early fasciotomy (8/13, 62 %) and those who underwent late fasciotomy (20/33, 61 %) (p = 1.0).Amputation was required in 7/46 patients (15 %), with 1/13 patient (8 %) in the early fasciotomy group and 6/33 patients (18 %) in the late fasciotomy group (p = 0.698). Skin grafting was performed for wound closure in 19 patients (42 %). In patients undergoing early fasciotomy, 75 % (9/12) required skin grafts for wound closure, whereas the rate in the late fasciotomy group was significantly lower at 30 % (10/33) (p = 0.019). The mean time to first debridement was significantly higher in infected patients [65.5 (SD 11.8) vs 57.8 (SD 11.4 h), p = 0034]. For wounds that required skin grafts, the average duration between the fasciotomy and initial debridement was significantly higher (68.5 vs 54 h), p = 0.001. CONCLUSION Fasciotomies performed in earthquake zones had higher infection rates compared to hospitals, though not statistically significant. Infections with potentially multi-drug resistant bacterias may increase the risk of complications like amputations. Timely debridement and efficient patient transfer remain essential to minimizing risks and improving outcomes.
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Affiliation(s)
- Saygin Kamaci
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
| | - Engin Turkay Yilmaz
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
| | - Ozan Tuncay
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
| | - Ulas Can Kolac
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
| | - Gazi Huri
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
| | - Omur Caglar
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
| | - Ahmet Mazhar Tokgozoglu
- Hacettepe University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey.
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Hegazi M, Nahmias J, Lekawa M, Dolich M, Kong A, Barrios C, Grigorian A. Risk Factors and Timing of Fasciotomy for Isolated Pediatric Lower Extremity Trauma. Am Surg 2025; 91:998-1005. [PMID: 40167298 DOI: 10.1177/00031348251331292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
BackgroundPrevious single-center reports have demonstrated a longer time from traumatic leg injury to fasciotomy in pediatric trauma patients (PTPs) with compartment syndrome. We hypothesized most fasciotomies in isolated pediatric lower extremity trauma (LET) are delayed (>6 hours from admission) and sought to investigate risk factors for pediatric fasciotomy.MethodsThe 2017-2020 TQIP database was queried for PTPs <17 years old with isolated injury to the leg. The primary outcome was fasciotomy. A multivariable logistic regression analysis was performed to identify associated risk factors for fasciotomy.ResultsFrom 97,217 PTPs, 358 (0.4%) underwent a fasciotomy, with a majority being delayed (60.3%); the median time to fasciotomy was 9.6 hours. Patients undergoing fasciotomy were older (median age 14 vs 12 years, P < 0.001), had a higher rate of severe LET (4.9% vs 1.2%, P < 0.001), and had tibial fracture (70.7% vs 27.6%, P < 0.001). They also had increased rates of in-hospital complications (14.2% vs 0.6%, P < 0.001), limb loss (1.1% vs <0.1%, P < 0.001), and longer median length of stay (LOS) (5 vs 2 days, P < 0.001). The most injured vessel in those undergoing fasciotomy was the popliteal artery (9.9%). Independent risk factors associated with fasciotomy included injuries to the popliteal vein (OR 30.72, CI 11.06-85.29, P < 0.001), femoral vein (OR 18.19, CI 6.40-51.69, P < 0.001), and popliteal artery (OR 13.74, CI 8.45-22.34, P < 0.001) and tibial fracture (OR 7.46, CI 5.57-10.00, P < 0.001).DiscussionMost fasciotomies were delayed for PTPs with isolated lower extremity injury. Popliteal vein injury increases the risk for fasciotomy 30-fold. Patients undergoing fasciotomy tend to have more complications and longer LOS.
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Affiliation(s)
- Mennatalla Hegazi
- Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
- Division of Trauma Surgery, Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Michael Lekawa
- Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
- Division of Trauma Surgery, Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Matthew Dolich
- Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
- Division of Trauma Surgery, Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Allen Kong
- Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
- Division of Trauma Surgery, Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Cristobal Barrios
- Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
- Division of Trauma Surgery, Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
- Division of Trauma Surgery, Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA
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Vecchione T, Bansal V, Shore BJ, Veneziano G, Sunder RA, Gurnaney H, Boretsky K. Acute compartment syndrome in pediatric patients with peripheral nerve blocks. Reg Anesth Pain Med 2025:rapm-2025-106423. [PMID: 40132889 DOI: 10.1136/rapm-2025-106423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Accepted: 03/07/2025] [Indexed: 03/27/2025]
Affiliation(s)
- Tricia Vecchione
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vipin Bansal
- Department of Anesthesiology, Children's Healthcare of Atlanta Arthur M Blank Hospital, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Benjamin Joel Shore
- Orthopedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Giorgio Veneziano
- Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rani A Sunder
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Harshad Gurnaney
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Karen Boretsky
- Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Uquilla-Loaiza G, Tupiza-Luna FK, Guerrero-Castillo GS, Izquierdo-Condoy JS. Acute Compartment Syndrome with Multiple Metacarpal Fractures in the Hand of a 5-Year-Old Boy: A Case Report of Successful Resolution with Delayed Primary Closure. J Clin Med 2025; 14:1304. [PMID: 40004834 PMCID: PMC11856109 DOI: 10.3390/jcm14041304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 01/30/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
Background: acute compartment syndrome (ACS) is an orthopedic emergency characterized by pathological pressure elevation within a confined anatomical space, posing a significant challenge in pediatric patients. ACS affects children in a very limited proportion, particularly involving the upper extremities, and diagnosis is complicated by subtle manifestations compared to adults. Case Presentation: we report on the case of a 5-year-old boy who sustained a crush injury to his right hand, resulting in multiple metacarpal fractures and subsequent ACS. The patient presented with severe pain, hand deformity, and restricted mobility. Radiological evaluation confirmed displaced fractures of multiple metacarpals. Emergency surgical intervention involved six incisions to decompress the dorsal and palmar compartments, release muscles, and decompress the median nerve. Healing involved delayed primary closure monitored every 72 h, resulting in an optimal outcome without complications. Conclusions: pediatric upper extremity ACS is rare, complicating diagnosis and treatment due to limited guidelines. This case underscores the effectiveness of early surgical decompression and delayed primary closure in achieving favorable outcomes. Individualized treatment strategies tailored to anatomical considerations and ACS severity are crucial to optimize patient care in pediatric surgical settings.
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Affiliation(s)
- Gonzalo Uquilla-Loaiza
- Departamento de Ortopedia y Traumatología, Hospital Vozandes Quito, Quito 170521, Ecuador
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Niklaus M, Reinshagen K, Wintges K. Non-fracture acute compartment syndrome in the upper extremity of a 14-year-old boy: A case report and review of the literature. Int J Surg Case Rep 2024; 121:109983. [PMID: 38964235 PMCID: PMC11268331 DOI: 10.1016/j.ijscr.2024.109983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Acute compartment syndrome (ACS) is an orthopaedic emergency affecting all age groups, yet diagnosis proves particularly difficult within the paediatric population and especially in the absence of fractures. CASE PRESENTATION In this case report, we detail a rare instance of a non-fracture acute compartment syndrome (NFACS) in a 14-year-old boy, initially missed due to lack of suspicion. Symptoms included swelling, severe pain, and initial paresthesia in the hand. Despite prompt forearm fasciotomy, severe post-traumatic Volkmann contracture ensued, resulting in limited upper extremity function despite multiple corrective surgeries. CLINICAL DISCUSSION Acute compart syndromes, occurring without fractures, often faces delayed diagnosis, particularly in paediatrics population. Clinical examination remains the diagnostic gold standard, with analgesia refractory pain warranting suspicion. Additional diagnostic criteria like ultrasound, MRI or CK blood values can be evaluated with reservation, especially in the paediatric population. CONCLUSION This case highlights the importance of increased vigilance in diagnostics for NFACS especially in children, in order to not overlook NFACS, due to the wide variability in the aetiology and clinical appearance. We emphasize the relevance of clinical diagnostics and point out an increased awareness of NFACS in analgesic refractory pain.
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Affiliation(s)
- Marina Niklaus
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Kristofer Wintges
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany.
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Hobbs M, Rahman HT, Raj R, Mandalaneni K, Pemminati S, Gorantla VR. Compartment Syndrome of the Lower Limb in Adults and Children and Effective Surgical Intervention and Post-surgical Therapies: A Narrative Review. Cureus 2024; 16:e63034. [PMID: 39050277 PMCID: PMC11268266 DOI: 10.7759/cureus.63034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Compartment syndrome (CS) can be defined as an acutely painful condition that occurs due to increased pressure within a compartment, resulting in reduced blood flow and oxygen to nerves and muscles within the limb. It is considered a surgical emergency, and a delayed diagnosis may result in ischemia and eventual necrosis of the limb. The majority of cases in adults are associated with high-energy trauma, more specifically, long bone fractures of the lower limb, while supracondylar fractures of the humerus are highly associated with CS in pediatric patients. CS may also develop gradually as a result of prolonged and ongoing physical activity such as running. In this narrative review, we discuss the anatomy, pathophysiology, methods of diagnosis, and effective management of CS in adults and children.
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Affiliation(s)
- Mikayla Hobbs
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Hira T Rahman
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Rhea Raj
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Kesava Mandalaneni
- Department of Neuroscience, St. George's University School of Medicine, St. George's, GRD
| | - Sudhakar Pemminati
- Department of Pharmacology, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Vasavi R Gorantla
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, USA
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Hu J, Yan J, Su Y. Mini approaches fasciotomy combined with vacuum sealing drainage for acute compartment syndrome caused by fractures in children. INTERNATIONAL ORTHOPAEDICS 2024; 48:1481-1487. [PMID: 37733064 DOI: 10.1007/s00264-023-05984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Acute compartment syndrome (ACS) is an urgent, critical condition that requires immediate fasciotomy once diagnosed. Traditionally, fasciotomy of the forearms and lower leg involves one or two long approaches. Our previous study demonstrated that mini approaches fasciotomy was an effective method to treat ACS. This study is aimed at further evaluating the limb functions and complications of mini approaches combined with vacuum sealing drainage (VSD) for treating ACS caused by fractures in the forearms and lower legs. METHODS This was a retrospective cross-sectional study, and after applying the inclusion and exclusion criteria, we reviewed 126 children who underwent mini treatment approaches for ACS from Jan 2008 to Jan 2022. The selected patients were divided into two groups: group A (ACS group; 58 patients aged 7.77±3.45 years) and group B (ACS combined with VSD; 68 patients aged 7.17±3.55 years). Patients' clinical data were collected. The patients were followed up, and muscle function in the forearms and lower legs was evaluated. RESULTS The overall incidence of lower legs and forearms ACS was 126/29642 (0.425%). The most common mechanisms of injury were fractures of the forearm (39/74, 52.7%), supracondylar humerus (31/74 41.9%), and elbow (4/74, 5.4%), while those for the lower legs were fractures of the proximal tibia (19/52, 36.5%), midshaft of tibia (25/52, 48.1%), and distal tibia (7/52, 13.5%). According to Flynn's assessment, no significant difference was observed between the two groups (p=0.151). However, the two groups showed significant differences in the hospitalization time (p=0.002) and incision infection rate (0.043). CONCLUSIONS Mini approaches fasciotomy combined with VSD is an effective and safe method to treat ACS of the forearms and lower legs caused by fractures in children. This method involves a single-stage surgery and is associated with shorter hospitalization time and incision infection.
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Affiliation(s)
- Jie Hu
- Orthopedics Department, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
- Jiangxi Hospital Affiliated Children's Hospital of Chongqing Medical University, Nanchang, China
- Orthopedics Department, Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
| | - Jingwen Yan
- Orthopedics Department, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
- Jiangxi Hospital Affiliated Children's Hospital of Chongqing Medical University, Nanchang, China
- Department of Clinical Medicine, Xiangya School of Medicine of Central South University, Changsha, China
| | - Yuxi Su
- Orthopedics Department, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.
- Jiangxi Hospital Affiliated Children's Hospital of Chongqing Medical University, Nanchang, China.
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Phillips WA. Musculoskeletal Issues in Pediatric Burn Patients. Semin Plast Surg 2024; 38:154-156. [PMID: 38746697 PMCID: PMC11090656 DOI: 10.1055/s-0044-1782651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2025]
Abstract
A burn injury affects virtually every organ system. The purpose of this article is to review musculoskeletal issues in children with burn injuries. Both acute and long-term problems will be discussed. A low threshold to consult a pediatric orthopaedist is recommended.
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Affiliation(s)
- William A. Phillips
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Shriners Children's Texas, Galveston, Texas
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9
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Davidson AL, Sutherland MA, Siska RC, Janis JE. Practical Review on the Contemporary Diagnosis and Management of Compartment Syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5637. [PMID: 38463703 PMCID: PMC10923313 DOI: 10.1097/gox.0000000000005637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024]
Abstract
Acute compartment syndrome (ACS) is a limb-threatening pathology that necessitates early detection and management. The diagnosis of ACS is often made by physical examination alone; however, supplemental methods such as compartment pressure measurement, infrared spectroscopy, and ultrasound can provide additional information that support decision-making. This practical review aims to incorporate and summarize recent studies to provide evidence-based approaches to compartment syndrome for both resource-rich and -poor settings among several patient populations.
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Affiliation(s)
- Amelia L. Davidson
- From the Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Mason A. Sutherland
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Robert C. Siska
- Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center, Columbus, Ohio
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10
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Bridges CS, Taylor TN, Bini T, Ontaneda AM, Coleman RD, Hill JF, Montgomery NI, Shenava VR, Gerow FT. Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support. J Pediatr Orthop 2024; 44:e285-e291. [PMID: 38084004 DOI: 10.1097/bpo.0000000000002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND When acute compartment syndrome (ACS) occurs in pediatric patients requiring venoarterial extracorporeal membrane oxygen (VA ECMO) support, there is little data to guide surgeons on appropriate management. The purpose of this study is to characterize the presentation, diagnosis, timeline, and outcomes of patients who developed this complication. METHODS This is a single-center retrospective case series of children below 19 years old on VA ECMO support who subsequently developed extremity ACS between January 2016 and December 2022. Outcomes included fasciotomy findings, amputation, mortality, and documented function at the last follow-up. RESULTS Of 343 patients on VA ECMO support, 18 (5.2%) were diagnosed with ACS a median 29 hours after starting ECMO. Initial cannulation sites included 8 femoral, 6 neck, and 4 central. Femoral artery cannulation was associated with an increased risk of ACS [odds ratio=6.0 (CI: 2.2 to 15), P <0.0001]. In the hospital, the mortality rate was 56% (10/18). Fourteen (78%) patients received fasciotomies a median of 1.2 hours after ACS diagnosis. Only 4 (29%) patients had all healthy muscles at initial fasciotomy, while 9 (64%) had poor muscular findings in at least 1 compartment. Patients with worse findings at fasciotomy had a significantly longer duration between ischemia onset and ACS diagnosis. Patients required a median of 1.5 additional procedures after fasciotomy, and only 1 (7%) developed a surgical site infection. Of the 7 surviving fasciotomy patients, 2 required amputations, 3 developed an equinus contracture, 1 developed foot drop, and 3 had no ACS-related deficits. Four patients did not receive fasciotomies: 3 were deemed too ill and later died, and 1 was diagnosed too late to benefit. The only surviving nonfasciotomy patient required bilateral amputations. CONCLUSIONS Pediatric ECMO-associated ACS is not exclusive to patients with femoral artery cannulation. The majority of fasciotomy patients were diagnosed with ACS after muscle necrosis had already started. We were unable to definitively conclude whether fasciotomies provide better outcomes. There is a need for increased awareness and earlier recognition of this rare yet potentially devastating complication. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Affiliation(s)
| | | | | | - Andrea M Ontaneda
- Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine
| | - Ryan D Coleman
- Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine
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Oswald B, DeFeo DR, Jude JW, Brillhart D, Borden N. Juke Stick: A Case of Pediatric Atraumatic Compartment Syndrome. Mil Med 2024; 189:e897-e901. [PMID: 37651579 DOI: 10.1093/milmed/usad355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/05/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
Compartment syndrome is usually due to trauma but can also have atraumatic causes. It is defined as a compromise of neurovascular and muscle function that presents symptomatically with the six P's: pain, pallor, paresthesia, paralysis, poikilothermia, and pulselessness. Diagnosis is confirmed by a delta pressure of <30 mmHg (diastolic blood pressure minus the compartment pressure). This case details a 15-year-old male football player with atraumatic compartment syndrome in the lateral compartment of the right lower leg. Symptoms of swelling and pain began 2 weeks before presentation after the patient was "juked." The patient's symptoms improved after a week of rest but worsened when he returned to practice. In the emergency department, the patient was able to ambulate with pain and declined pain medication. Examination revealed severe tenderness, mildly decreased strength, decreased sensation, and edema in the lateral compartment via bedside ultrasound. Because of the concern for compartment syndrome, pressure was checked with a disposable manometer (Compass CT disposable pressure transducer) revealing a delta pressure of 26 mmHg. The patient consequently underwent fasciotomy, eventually returning to baseline function without deficits. Awareness of this atypical presentation of compartment syndrome will assist providers in making a critical diagnosis and preventing severe complications and disability. This case also demonstrates the potential of disposable pressure transducers for cost-effective and accurate diagnostic confirmation of compartment syndrome in the emergency department.
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Affiliation(s)
- Brandon Oswald
- Emergency Medicine Residency, Carl R. Darnall Army Medical Center, Fort Cavazos, TX 76544, USA
| | - Devin R DeFeo
- Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
| | - Joseph W Jude
- Emergency Medicine Residency, Carl R. Darnall Army Medical Center, Fort Cavazos, TX 76544, USA
| | - Dan Brillhart
- Emergency Medicine Residency, Carl R. Darnall Army Medical Center, Fort Cavazos, TX 76544, USA
| | - Nathan Borden
- Emergency Medicine Residency, Carl R. Darnall Army Medical Center, Fort Cavazos, TX 76544, USA
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Xu Z, Teng J, Wu Y, Xiang F, Xie Y, Xiang J, Liu C, Song Z, Tang Z, Wen J, Li Y, Xiao S. Comparison of midterm efficacy of Kirschner wires and elastic intramedullary nails after closed reduction of Judet type 3 radial neck fractures in children: a multicenter study. Front Pediatr 2024; 12:1350993. [PMID: 38390275 PMCID: PMC10881823 DOI: 10.3389/fped.2024.1350993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The objective of this study was to compare the midterm efficacy of Kirschner wires and elastic intramedullary nails after the closed reduction treatment of Judet 3 radial neck fractures in children. METHODS This was a retrospective multicenter study of patients diagnosed with Judet type 3 radial neck fractures who underwent closed reduction and internal fixation at four tertiary hospitals from January 2019 to December 2021. Gender, age, fracture type, operation time, follow-up time, x-ray results and complications were collected. The recovery of elbow joint between the two internal fixation methods, elbow motion and complications at the last follow-up were compared. RESULTS The average operation time of EIN group was statistical significantly increased compared with KW group. There were no significant differences in MEPS score and ROM 3 months after surgery between the two groups, but the ROR Angle of EIN group was statistical significantly increased compared with KW group 3 months after surgery. There were no significant differences in MEPS score, ROM and ROR at the last follow-up. The incidence of complications in EIN group was significantly lower than that in KW group. CONCLUSION The use of elastic intramedullary nails fixation or Kirschner wires fixation in the treatment of radial neck fractures in children can both achieve satisfactory fracture reduction and healing. Compared with elastic intramedullary nails, the operation time of Kirschner wires fixation is shorter, and the internal fixation does not need to be removed under anesthesia again, but the complication rate is higher.
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Affiliation(s)
- Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Jun Teng
- Department of Pediatric Orthopedics, Zhangjiajie People’s Hospital, Zhangjiajie, Hunan, China
| | - Yuyuan Wu
- Department of Pediatric Orthopedics, Traditional Chinese Medicine Hospital in Huaihua, Huaihua, Hunan, China
| | - Feng Xiang
- Department of Orthopedics, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Yuyin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Junqiao Xiang
- Department of Pediatric Orthopedics, Zhangjiajie People’s Hospital, Zhangjiajie, Hunan, China
| | - Can Liu
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha, Hunan, China
| | - Zhenqi Song
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Zhongwen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha, Hunan, China
| | - Yanjun Li
- Department of Orthopedics, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
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OBEY MR, SHLYKOV MA, NICKEL KB, KELLER M, HOSSEINZADEH P. Incidence and risk factors for acute compartment syndrome in pediatric tibia fractures. J Pediatr Orthop B 2023; 32:401-404. [PMID: 35502734 PMCID: PMC9630170 DOI: 10.1097/bpb.0000000000000985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute compartment syndrome (ACS) is a rare complication following traumatic injuries in pediatric patients, and tibia fractures represent the most common cause of ACS. To determine the incidence and risk factors of developing ACS, State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, were used to retrospectively identify patients 1-18 years of age with tibia fractures from 2006 to 2015 (quarter 3). The HCUP Nationwide Emergency Department Sample for nationwide data was also queried. Multivariable generalized estimating equations models were used to determine risk factors associated with development of ACS. A total of 50 640 patients with tibia fractures were studied, and 309 cases of ACS were identified. The incidence of ACS was 0.6 and 5.5% in the all tibia and open tibia fracture groups, respectively. Twenty-three cases of ACS (7.4% of all ACS) were diagnosed after discharge from the index admission, which was more common in teens treated nonoperatively. Predictors of increased ACS risk in the all tibia fracture group included age 13-18 [relative risk (RR): 4.04)], open fractures (RR: 3.83), and motor vehicle crash (MVC) mechanism (RR: 5.69). Nationwide, open and operatively treated fractures had an increased ACS rate (3.98 and 5.51%, respectively). Teenagers, open fractures, and MVC mechanisms were most strongly associated with ACS. ACS can present in a delayed fashion, as evidenced by postindex cases.
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Affiliation(s)
- Mitchel R. OBEY
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Maksim A. SHLYKOV
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Katelin B. NICKEL
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Matthew KELLER
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
| | - Pooya HOSSEINZADEH
- Investigation performed at the St. Louis Children’s Hospital, St. Louis, MO
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de Farias AS, Cristino JS, da Costa Arévalo M, Carneiro Junior A, Gomes Filho MR, Ambrosio SA, Nickenig Vissoci J, Wen FH, Azevedo Machado V, Sachett J, Monteiro W. Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives. Toxins (Basel) 2023; 15:352. [PMID: 37368653 PMCID: PMC10305629 DOI: 10.3390/toxins15060352] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023] Open
Abstract
Snakebites are a major public health problem in the Brazilian Amazon and may lead to local complications and physical deficiencies. Access to antivenom treatment is poorer in indigenous populations compared to other populations. In this study, we report three cases of long-term severe disabilities as a result of Bothrops atrox snakebites in indigenous children, according to the narratives of the parents. The three cases evolved to compartment syndrome, secondary bacterial infection and extensive necrosis. The cases are associated with delayed antivenom treatment due to very fragmented therapeutic itineraries, which are marked by several changes in means of transport along the route. The loss of autonomy at such an early stage of life due to a disability caused by a snakebite, as observed in this study, may deprive children of sensory and social experiences and of learning their future roles in the community. In common to all cases, there was precarious access to rehabilitation services, which are generally centralized in the state capital, and which leads to a prolonged hospitalization of patients with severe snakebite, and distances them from their territory and family and community ties. Prospective studies should be conducted in the Amazon that estimate the burden of disabilities from snakebites in order to formulate public policies for the treatment and rehabilitation of patients through culturally tailored interventions.
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Affiliation(s)
- Altair Seabra de Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, Brazil; (A.S.d.F.); (J.S.C.); (V.A.M.); (J.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Joseir Saturnino Cristino
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, Brazil; (A.S.d.F.); (J.S.C.); (V.A.M.); (J.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Macio da Costa Arévalo
- Distrito Sanitário Especial Indígena Alto Rio Solimões, Secretaria Especial de Saúde Indígena, Tabatinga 69640-000, Brazil; (M.d.C.A.); (M.R.G.F.)
| | - Alceonir Carneiro Junior
- Distrito Sanitário Especial Indígena Manaus, Secretaria Especial de Saúde Indígena, Manaus 69050-010, Brazil;
| | - Manoel Rodrigues Gomes Filho
- Distrito Sanitário Especial Indígena Alto Rio Solimões, Secretaria Especial de Saúde Indígena, Tabatinga 69640-000, Brazil; (M.d.C.A.); (M.R.G.F.)
| | | | - João Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC 27710, USA;
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Fan Hui Wen
- Instituto Butantan, São Paulo 05503-900, Brazil;
| | - Vinícius Azevedo Machado
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, Brazil; (A.S.d.F.); (J.S.C.); (V.A.M.); (J.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, Brazil; (A.S.d.F.); (J.S.C.); (V.A.M.); (J.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus 69065-130, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus 69065-001, Brazil; (A.S.d.F.); (J.S.C.); (V.A.M.); (J.S.)
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
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Wang T, Guo J, Long Y, Hou Z. Predictors of acute compartment syndrome in patients with tibial fractures: a meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:51-65. [PMID: 36450888 DOI: 10.1007/s00264-022-05643-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/12/2022] [Indexed: 12/04/2022]
Abstract
STUDY DESIGN This is the first meta-analysis focusing on the risk factors related to ACS after tibial fractures. BACKGROUND Acute compartment syndrome (ACS) is a serious complication that affects 2-9% of tibial fracture patients. It is importance of identifying the predictors of ACS in patients with tibial fractures. QUESTIONS/PURPOSES We performed a meta-analysis to identify the risk factors of ACS after tibial fracture. METHODS We searched articles in the English databases, such as PubMed, Embase, and the Cochrane Library and the Chinese databases including CNKI and WAN FANG. We collected data related to ACS from included studies and analyzed data by RevMan 5.3 and STATA 12.0. RESULTS The rate of ACS was 2.7% (10,708 of 398,414 patients) from 16 included articles. Our data showed that younger age (p < 0.00001, OR = - 7.93, 95% CI [- 9.34, - 6.25]), male patients (p < 0.00001, OR = 2.17, 95% CI [2.07, 2.28]), patients without a history of hypertension (p < 0.00001, OR = 0.69, 95% CI [0.64, 0.74]), with a history of smoking (p < 0.00001, OR = 1.38, 95% CI [1.30, 1.46]), and patients with fibular fractures (p = 0.001, OR = 2.68, 95% CI [1.47, 4.87]), closed fracture (p = 0.02, OR = 0.86, 95% CI [0.75, 0.98]), high-energy injury (p = 0.003, OR = 0.37, 95% CI [0.19, 0.71]), motorized accident (p = 0.0009, OR = 0.41, 95% CI [0.24, 0.69]), proximal fracture, AO-C-type fracture, comminuted fracture, and Schatzker grade IV-VI fracture were associated with the development of ACS. Additionally, femoral displacement ratio and tibial widening ratio in the ACS groups were significantly higher than in the non-ACS group. CONCLUSION Many factors were found to be associated with the development of ACS following tibial fractures. We provide references when we met the above characteristics of patients to rapidly identify and highly concern ACS.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yubin Long
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Toğaç S, Eken G, Ermutlu C, Sarisözen B. Forearm Compartment Pressure Change in Children Operated for Supracondylar Humerus Fracture. J Pediatr Orthop 2022; 42:509-515. [PMID: 35980756 DOI: 10.1097/bpo.0000000000002220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Soner Toğaç
- Department of Orthopedics and Traumatology, Manisa Merkezefendi State Hospital, Manisa
| | - Gökay Eken
- Department of Orthopedics and Traumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Cenk Ermutlu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Bartu Sarisözen
- Department of Orthopedics and Traumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Macken AA, Eygendaal D, van Bergen CJA. Diagnosis, treatment and complications of radial head and neck fractures in the pediatric patient. World J Orthop 2022; 13:238-249. [PMID: 35317255 PMCID: PMC8935328 DOI: 10.5312/wjo.v13.i3.238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/11/2021] [Accepted: 02/12/2022] [Indexed: 02/06/2023] Open
Abstract
Radial head and neck fractures represent up to 14% of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient. In up to 39% of proximal radius fractures, there is a concomitant fracture, which can easily be overlooked on the initial standard radiographs. The treatment options for proximal radius fractures in children range from non-surgical treatment, such as immobilization alone and closed reduction followed by immobilization, to more invasive options, including closed reduction with percutaneous pinning and open reduction with internal fixation. The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient; an angulation of less than 30 degrees and translation of less than 50% is generally accepted, whereas a higher degree of displacement is considered an indication for surgical intervention. Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures, range of motion and complications compared to severely displaced fractures requiring surgical intervention. With proper management, good to excellent results are achieved in most cases, and long-term sequelae are rare. However, severe complications do occur, including radio-ulnar synostosis, osteonecrosis, rotational impairment, and premature physeal closure with a malformation of the radial head as a result, especially after more invasive procedures. Adequate follow-up is therefore warranted.
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Affiliation(s)
- Arno A Macken
- Department of Orthopedic Surgery, Amphia Hospital, Breda 4818 CK, Noord-Brabant, Netherlands
- Department of Orthopedic Surgery and Sports medicine, Erasmus Medical Centre, Rotterdam 3015 GD, South-Holland, Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery and Sports medicine, Erasmus Medical Centre, Rotterdam 3015 GD, South-Holland, Netherlands
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18
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Abstract
Pediatric acute compartment syndrome (ACS) is an orthopedic emergency which requires timely recognition and management. There are unique considerations in children, as they may present with a wide array of symptoms and capacities to communicate. We sought to investigate the presentations, treatments and outcomes of pediatric ACS, hypothesizing that decompressive fasciotomy results in good outcomes, even with delayed treatment (>24 h). We performed a retrospective review of pediatric ACS from 2009 to 2018. Exclusion criteria were age ≥18 years, exertional compartment syndrome, and incomplete data. Twenty-one patients (mean age 11 years) were included. Swelling (100%) and worsening pain (100%) were the most common presenting signs and symptoms followed by paresthesias (75%). Increasing analgesia requirements were documented in six (29%) patients. Compartment pressures were measured in 52% of patients. All patients were managed with decompressive fasciotomies, which were performed at a median time of 20 h from injury. Strength and range of motion deficits (10%) were the most commonly reported complications. There were no infections. All patients who were treated in a delayed fashion (≥24 h) were found to have a good functional recovery, but 38% had minor complications. Overall, patients had good outcomes, achieving full functional recovery with return to preinjury activity level. Pediatric ACS should be approached as a distinct clinical entity from adult ACS, where risks of infection and wound complications from delayed fasciotomy generally outweigh the benefits. We recommend considering decompressive fasciotomy for all cases of pediatric ACS, including those with prolonged time from injury to diagnosis.
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Affiliation(s)
- James Lin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center
| | - Walter P Samora
- Department of Orthopaedics, The Ohio State University Wexner Medical Center
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Julie B Samora
- Department of Orthopaedics, The Ohio State University Wexner Medical Center
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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19
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MacKay BJ, Cox CT, Valerio IL, Greenberg JA, Buncke GM, Evans PJ, Mercer DM, McKee DM, Ducic I. Evidence-Based Approach to Timing of Nerve Surgery: A Review. Ann Plast Surg 2021; 87:e1-e21. [PMID: 33833177 PMCID: PMC8560160 DOI: 10.1097/sap.0000000000002767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023]
Abstract
ABSTRACT Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery. MEDLINE and EMBASE databases were systematically reviewed for clinical data on nerve repair and reconstruction to define the current understanding of timing and other factors affecting outcomes. Special attention was given to sensory, mixed/motor, nerve compression syndromes, and nerve pain. The data presented in this review may assist surgeons in making sound, evidence-based clinical decisions regarding timing of nerve surgery.
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Affiliation(s)
- Brendan J. MacKay
- From the Texas Tech University Health Sciences Center
- University Medical Center, Lubbock, TX
| | | | - Ian L. Valerio
- Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Peter J. Evans
- Orthopaedic Surgery, Cleveland Clinic of Florida, Weston, FL
| | - Deana M. Mercer
- Department of Orthopaedics and Rehabilitation, The University of New Mexico, Albuquerque, NM
| | - Desirae M. McKee
- From the Texas Tech University Health Sciences Center
- University Medical Center, Lubbock, TX
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20
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Bilateral compartment of the hands in prolidase deficiency syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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Nathanson MH, Harrop-Griffiths W, Aldington DJ, Forward D, Mannion S, Kinnear-Mellor RGM, Miller KL, Ratnayake B, Wiles MD, Wolmarans MR. Regional analgesia for lower leg trauma and the risk of acute compartment syndrome: Guideline from the Association of Anaesthetists. Anaesthesia 2021; 76:1518-1525. [PMID: 34096035 PMCID: PMC9292897 DOI: 10.1111/anae.15504] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/30/2022]
Abstract
Pain resulting from lower leg injuries and consequent surgery can be severe. There is a range of opinion on the use of regional analgesia and its capacity to obscure the symptoms and signs of acute compartment syndrome. We offer a multi-professional, consensus opinion based on an objective review of case reports and case series. The available literature suggested that the use of neuraxial or peripheral regional techniques that result in dense blocks of long duration that significantly exceed the duration of surgery should be avoided. The literature review also suggested that single-shot or continuous peripheral nerve blocks using lower concentrations of local anaesthetic drugs without adjuncts are not associated with delays in diagnosis provided post-injury and postoperative surveillance is appropriate and effective. Post-injury and postoperative ward observations and surveillance should be able to identify the signs and symptoms of acute compartment syndrome. These observations should be made at set frequencies by healthcare staff trained in the pathology and recognition of acute compartment syndrome. The use of objective scoring charts is recommended by the Working Party. Where possible, patients at risk of acute compartment syndrome should be given a full explanation of the choice of analgesic techniques and should provide verbal consent to their chosen technique, which should be documented. Although the patient has the right to refuse any form of treatment, such as the analgesic technique offered or the surgical procedure proposed, neither the surgeon nor the anaesthetist has the right to veto a treatment recommended by the other.
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Affiliation(s)
- M H Nathanson
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, President, Association of Anaesthetists (Co-Chair), Nottingham, UK
| | - W Harrop-Griffiths
- Imperial College, Vice President, Royal College of Anaesthetists (Co-Chair), London, UK
| | - D J Aldington
- Hampshire Hospitals NHS Trust, British Pain Society, Hampshire, UK
| | - D Forward
- Department of Trauma and Orthopaedic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Mannion
- Department of Anaesthesiology, South Infirmary Victoria University Hospital, Irish Standing Committee, Association of Anaesthetists, Cork, Ireland
| | - R G M Kinnear-Mellor
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Surgeon Commander, Royal Navy; Chair, Defence Medical Services Military Pain Special Interest Group, Nottingham, UK
| | - K L Miller
- Department of Paediatric Anaesthesia, Birmingham Women's and Children's NHS Foundation Trust, Trainee Committee, Association of Anaesthetists, Birmingham, UK
| | - B Ratnayake
- Department of Anaesthesia, Kingston Hospital NHS Trust, Immediate Past President, British Society of Orthopaedic Anaesthetists, Immediate Past President, British Society of Orthopaedic Anaesthetists, Kingston-upon-Thames, UK
| | - M D Wiles
- Department of Anaesthesia and Operating Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M R Wolmarans
- Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Past-President, Regional Anaesthesia UK (RA-UK), Norwich, UK
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22
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Teng HC, Arslan-Carlon V. Pediatric acute compartment syndrome due to surgical positioning: A case report. Paediatr Anaesth 2021; 31:360-361. [PMID: 33251709 PMCID: PMC8454859 DOI: 10.1111/pan.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Pediatric acute compartment syndrome from surgical positioning may be difficult to recognize. Increasing anxiety and analgesic requirements can suggest developing compartment syndrome. We present a case of compartment syndrome after a non-orthopedic surgery.
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23
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Jerome TJ. Acute upper limb compartment syndrome in children: special focus on nerve recovery. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000158. [DOI: 10.1136/wjps-2020-000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/04/2022] Open
Abstract
BackgroundMany studies have discussed acute compartment syndrome in children associated with or without fractures and have given their visible perspectives. Little is known about the nerve involvement and the factors associated with recovery patterns in these patients. We intend to propose that ischemic nerve and muscles tend to regenerate after surgical decompression but in a different pattern and the given circumstances.MethodsTwenty-four children with acute compartment syndrome in the upper limb were analyzed between 2009 and 2015. Data included demographic features of these patients, the time interval between the injury and surgery, and the attempt to correlate with motor and sensory recovery.ResultsThe average follow-up was 67.3 months (range 59–80). Of the 24, 14 patients (58%) had immediate recovery of motor and sensory functions. The remaining 10 patients had variable recovery patterns with a mean time for the radial nerve, median nerve and ulnar nerve motor recovery of 6.0, 7.5 and 8.5 months, respectively, and sensory recovery at 12, 12 and 13 months, respectively. The overall study had a mean sensory recovery as per the Medical Research Council (MRC) of S3 in 3 (12%) and S4 in 21 (88%). The mean 2-point discrimination (2PD) was 6.9 mm (range 5–10). Twenty-one patients (88%) had a full range of movements at their final follow-up with a mean Visual Analog Scale score of 0.6; a quick Disabilities of the Arm, Shoulder and Hand score of 5.9 (range 2.3–25.0) and a Mayo wrist score of 79.ConclusionsThere was a definite motor and sensory recovery in patients who underwent surgical decompression in acute compartment syndrome of the upper limb irrespective of age, gender, delay in presentation and various etiologies. The motor and nerve fibers can regenerate after ischemic sequela of compartment syndrome.
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24
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Risk factors for developing acute compartment syndrome in the pediatric population: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:839-844. [PMID: 32107640 DOI: 10.1007/s00590-020-02643-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Acute compartment syndrome (ACS) is often difficult to diagnose in pediatric patients due to their erratic symptomatology. Therefore, it is of paramount importance to identify at-risk patients to facilitate a prompt diagnosis. This study aims to identify risk factors for the development of ACS in the pediatric population. METHODS We included studies comprised of pediatric patients with traumatic ACS. We excluded studies evaluating compartment syndrome secondary to exertion, vascular insult, abdominal processes, burns, and snake bites. Heterogeneity was addressed by subgroup analysis, and whenever it remained significant, we utilized a random-effects meta-analysis for data pooling. The protocol has been registered at PROSPERO (ID = CRD42019126603). RESULTS We included nine studies with 380,411 patients, of which 1144 patients were diagnosed with traumatic ACS. The average age was 10 years old, and 67% of patients were male. Factors that were significantly associated with ACS were: open radius/ulna fractures (OR 3.56 CI 1.52-8.33, p = 0.003), high-energy trauma (OR 3.51 CI 1.71-7.21, p = 0.001), humerus fractures occurring concurrently with forearm fractures (OR 3.49 CI 1.87-6.52, p < 0.001), open tibia fractures (OR 2.29 CI 1.47-3.55, p < 0.001), and male gender (OR 2.06 CI 1.70-2.51, p < 0.001). CONCLUSION In the present study, open fractures, high-energy trauma, concurrent humerus and forearm fractures, and male gender significantly increased the risk of developing ACS in the pediatric population. Clinicians should raise their suspicion for ACS when one or multiple of these factors are present in the right clinical context. TYPE OF STUDY Systematic review and meta-analysis. LEVEL OF EVIDENCE III.
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Abstract
Anesthetic management of pediatric orthopedic patients is uniquely challenging. Approach to the pediatric patient must consider heightened preoperative anxiety and its postoperative behavioral and pain effects. Frequent respiratory infections can complicate timing of surgery and anesthetic care. Perioperative pain management usually involves a multimodal pharmacologic approach with the goal of minimizing opioid requirements. Regional anesthesia is valuable for postoperative pain control. Safety of its use in the pediatric population has been confirmed in recent studies. Included for discussion are fractures, slipped capital femoral epiphysis, club foot, and scoliosis.
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Affiliation(s)
- Jeffrey P Wu
- Department of Anesthesiology, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA.
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