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. 2016 Oct;10(5):453-60.
doi: 10.1007/s11832-016-0766-0. Epub 2016 Aug 18.

Compartment syndrome in infants and toddlers

Alexander Broom  1 , Mathew D Schur  1 , Alexandre Arkader  2 , John Flynn  2 , Alex Gornitzky  2 , Paul D Choi  3
Affiliations

Compartment syndrome in infants and toddlers

Alexander Broom et al. J Child Orthop. 2016 Oct.

Abstract

Purpose: To study the cause, diagnosis, treatment and outcome of acute compartment syndrome in infants and toddlers aged <3 years.

Methods: Fifteen patients aged <3 years with acute compartment syndrome were identified from two large pediatric trauma centers over a fifteen-year period. All children underwent fasciotomy. The mechanism of injury, time of injury, time to diagnosis, compartment pressures, time to fasciotomy, and outcome at the time of the latest follow-up were recorded.

Results: Nine (60 %) of fifteen patients developed compartment syndrome secondary to trauma, four (4/15, 27 %) due to infection, and two (2/15, 13 %) due to intravenous infiltration. The average time from injury or hospital admission to fasciotomy was 31.8 h (range 2.9-136.3 h). In general, the functional outcome was excellent at the latest follow-up with thirteen (13/15, 87 %) patients having an excellent outcome. No cases of Volkmann's ischemia were noted at the time of fasciotomy, even when performed as late as 5 days after injury.

Conclusions: Compared to the general pediatric population, the diagnosis of compartment syndrome in infants and toddlers may be further delayed, i.e., >24 h after injury. Despite delays in diagnosis and time to treatment, the present study shows that outcomes in infants and toddlers remain favorable even when fasciotomy is performed 48-72 h after injury.

Level of evidence: Case series, level IV.

Keywords: Compartment syndrome; Fasciotomy; IV infiltration; Infection; Pediatric.

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Conflict of interest statement

Compliance with ethical standards Funding This study was not funded. Conflict of interest AB declares he no conflict of interest. MDS declares he has no conflict of interest. AA is an unpaid consultant for OrthoPediatrics. JF receives royalties from Biomet, publishing royalties, financial or material support from Wolters Kluwer Health–Lippincott Williams & Wilkins. AG declares he has nothing to disclose. PDC is a paid consultant for Integra and Stryker and received payment for development of educational presentations including service on speakers’ bureaus. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent A waiver of informed consent was obtained from our institutional review board for all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Breakdown of mechanism of injury resulting in compartment syndrome Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles, USA
Fig. 2
Fig. 2
Time from injury or admission to diagnosis by type of injury Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles, USA
Fig. 3
Fig. 3
Breakdown of location of compartment syndrome Reproduced with permission from the Children’s Orthopaedic Center, Los Angeles, USA
See this image and copyright information in PMC

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