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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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Baseball Related Injuries: A Case Report on Acute Compartment Syndrome of the Forearm. Case Rep Orthop 2022; 2022:5449913. [PMID: 35295816 PMCID: PMC8918371 DOI: 10.1155/2022/5449913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
Acute compartment syndrome is a difficult diagnosis to make due to its wide range of clinical presentations. Delay or misdiagnosis can cause devastating consequences such as Volkmann's ischemic contracture, permanent nerve damage, amputation, and death. Lower extremity compartment syndrome is more common than upper extremity compartment syndrome, with the forearm being the most common location for upper extremity compartment syndrome. Acute compartment syndrome is most caused by acute fracture trauma but can also be due to soft tissue crush injuries or vascular problems. We report a unique case of a male umpire being struck on the forearm by a baseball with subsequent progression to an acute compartment syndrome that required emergent fasciotomies. The patient made a full recovery with no known long-term sequelae.
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Chen G, Cui L, Shi J, Zhang P, Li J, Wang Z, Song J, Wang B. Humerus trochlear angle (HTa)-a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures. BMC Musculoskelet Disord 2021; 22:950. [PMID: 34781909 PMCID: PMC8594185 DOI: 10.1186/s12891-021-04717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The supracondylar humerus fractures are the most common fracture in children's elbows. Generally, close reduction and percutaneous pinning can provide satisfactory outcomes after adequate reduction. Baumann angle is commonly used to evaluate reduction quality, however, it may fail to assess reduction well when the elbow is in flexion and/or when the patient is young. We conducted this study to evaluate the potential value of the humerus trochlear angle (HTa) for the reduction evaluation and compare it with the Baumann angle. METHODS We retrospectively reviewed supracondylar humerus fractures in our trauma center from 2016 to 2019. Patients were grouped as followed: in the HTa group, an arthrogram was used to evaluate the HTa angle and reduction (HTa, defined by the intersection of the axis of the humerus shaft and the tangent of the articular surface of the trochlear); In the Baumann group, the Baumann angle was used to assess the reduction. Baumann angle ratio (BA of injured side/BA of contralateral side) was calculated to evaluate the reduction quality between groups. Flynn's grading criteria were utilized to evaluate both function and cosmetic outcomes in two groups during the follow-up. Operation time, fluoroscopy shots, complications and Flynn's grading scores were compared between groups. RESULTS A total of 57 patients with an average age of 4.62 years and follow-up duration of 21.49 ± 5.40 months were included in the analysis. The gender and age distributions were similar in the two groups. Fluoroscopy shots in the HTa group were significantly less than in Baumann group (16.17 ± 0.73 vs. 21.85 ± 0.78, p < 0.0001), and operation time were also less in HTa group (45.78 ± 1.96 min vs. 62.21 ± 1.58 min, p < 0.0001). Baumann ratio showed no significant difference between the two groups (1.002 ± 0.023 in the Baumann group and 1.01 ± 0.023 in HTa group, p < 0.0001). Length of hospitalization, complications, and Flynn's grading scores were similar between groups. The HTa angle was positively correlated with Baumann angle in the HTa group (R-value is 0.71 and P = 0.0002). CONCLUSIONS There was no significant difference in reduction quality and Flynn's scores between HTa and Baumann groups. Furthermore, HTa was associated with shorter operation time and less radiation exposure in this investigation. Therefore, HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children.
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Affiliation(s)
- Gang Chen
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Lu Cui
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Jiaqi Shi
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Peng Zhang
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Jun Li
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Zijian Wang
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Jun Song
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China.
| | - Bangjun Wang
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China.
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Gibson ME, Stork N. Gait Disorders. Prim Care 2021; 48:395-415. [PMID: 34311847 DOI: 10.1016/j.pop.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As a child matures so does the child's gait pattern. Gait changes in pediatric patients will be expected and sequential as developmental milestones. Gait changes may also represent normal variations along an appropriate spectrum. There are times when changes in gait are due to urgent orthopedic or medical conditions, and those should not be overlooked. A good understanding of pediatric gait development and a basic understanding of gait assessment are critical for the primary care physician who cares for children.
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Affiliation(s)
- Margaret E Gibson
- Department of Community and Family Medicine, University of Missouri Kansas City, Kansas City, MO, USA.
| | - Natalie Stork
- Department of Orthopaedics and Musculoskeletal Medicine, Childrens Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA; Orthopaedic Surgery, University of Missouri-Kansas City School of Kansas City, Kansas City, MO, USA
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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: 18] [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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Do Patient-specific or Fracture-specific Factors Predict the Development of Acute Compartment Syndrome After Pediatric Tibial Shaft Fractures? J Pediatr Orthop 2020; 40:e193-e197. [PMID: 31157755 DOI: 10.1097/bpo.0000000000001410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tibial shaft fractures are the most common injuries preceding acute compartment syndrome (ACS), so it is important to understand the incidence of and risk factors for ACS after pediatric tibial shaft fractures. The purposes of this study were to determine the rate at which ACS occurs and if any patient or fracture characteristics are significantly associated with developing ACS. METHODS All patients aged 5 to 17 years treated for a tibial shaft fracture at a level 1 pediatric trauma center, a level 1 adult trauma center, and an outpatient orthopaedic practice between 2008 and 2016 were retrospectively identified. Demographics, mechanisms of injury, and fracture characteristics were collected from the medical records. Radiographs were reviewed by study authors. ACS was diagnosed clinically or by intracompartmental pressure measurement. Univariable analysis was performed using the Fisher exact test for nominal variables and simple logistic regression for continuous variables. Multivariable analysis was performed using stepwise logistic regression. RESULTS Among 515 patients with 517 tibial shaft fractures, 9 patients (1.7%) with 10 (1.9%) fractures developed ACS at a mean age of 15.2 years compared with a mean age of 11 years in patients without ACS (P=0.001). One patient with bilateral tibial fractures developed ACS bilaterally. Age greater than 14 years (P=0.006), higher body mass index (P<0.001), motorcycle or motor vehicle accidents (P=0.034), comminuted and segmental tibial shaft fractures (P<0.001), ipsilateral fibular fracture (P=0.002), and associated orthopaedic injuries (P=0.032) were all significantly more common in the ACS group. CONCLUSIONS ACS developed in 1.7% of the patients with tibial shaft fractures in this retrospective study-a rate significantly lower than previously reported. Age greater than 14 years, higher body mass index, motor vehicle or motorcycle accidents, comminuted or segmental fracture pattern, ipsilateral fibular fracture, and associated orthopaedic injuries are all significantly associated with its development. LEVELS OF EVIDENCE Level III-retrospective comparative study.
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Acute Compartment Syndrome in Children: Don’t Miss This Elusive Diagnosis. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Current Approach to the Evaluation and Management of Acute Compartment Syndrome in Pediatric Patients. Pediatr Emerg Care 2019; 35:432-437. [PMID: 31157749 DOI: 10.1097/pec.0000000000001855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute compartment syndrome is an emergent condition caused by increased pressure within a closed compartment. The most common etiology is fractures, but there a number of atraumatic causes cited in the literature. Acute compartment syndrome occurs most frequently in the anterior compartment of the lower leg, followed by the volar forearm. Patients may present with severe pain, pain with passive stretch, swelling, paresthesias, numbness, weakness, decreased pulses, and delayed capillary refill. No finding in isolation can exclude the diagnosis. Direct measurement of the intracompartmental pressure is the most important diagnostic test. Treatment involves removal of compressive dressings and surgical consultation for emergent fasciotomy.
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