Compartment Syndrome in Ipsilateral Humerus and Forearm Fractures in Children

Blakemore, Laurel C.; Cooperman, Daniel R.; Thompson, George H.; Wathey, Cynthia; Ballock, R. Tracy

doi:10.1097/00003086-200007000-00006

Cited by 115 publications

(64 citation statements)

References 12 publications

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“…The incidence of floating elbow injuries is between 3-13% [5]. It is a severe injury and some authors have reported a high incidence of compartment syndrome and in most cases they are associated with highenergy trauma [6][7][8]. Stanitski and Micheli were the first to use the term floating elbow to describe combination of supracondylar and both bone forearm fractures where in the elbow is effectively dissociated from the rest of the limb [7].…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral fracture of the supracondylar humerus and forearm in children

Hussain¹

2014

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comIpsilateral fracture of the supracondylar humerus and forearm in children Shahid Hussain ABSTRACT Introduction: Simultaneous ipsilateral fracture of the elbow and forearm (floating elbow) is an uncommon injury and treatment recommendations are controversial. The aim of our study was to evaluate the incidence of ipsilateral fractures of the upper limb and to present our experience in dealing with such injuries and to review the literature relating to this topic. The following variables were used: age, gender, side, mechanism of injury, type of fracture, classification, treatment methods, complications and outcome. Case Series: We prospectively followed five children who presented with displaced supracondylar fractures of the humerus associated with a forearm fracture of the same limb. All patients underwent emergency procedures in the form of closed reduction and K-wire fixation/ cast fixation. At a minimum follow up of 24 months, all patients were assessed clinically and radiologically and the results evaluated according to a conventional scoring system. Four patients had excellent or good outcomes, and there was one poor result. Conclusion:The floating elbow is an indicator of a high energy injury. The incidence of open fractures, compartment syndrome and nerve injury and the need to perform an open reduction were higher than those recorded for isolated supracondylar or forearm fractures. The existing controversies in the management of such a complex injury and associated problems are outlined. A pertinent literature review is also included.

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Section: Introductionmentioning

confidence: 99%

Ipsilateral fracture of the supracondylar humerus and forearm in children

Hussain¹

2014

IJCRI

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“…The incidence of compartment syndrome following forearm fracture was found to be 1.04 % (20/1,905), with a significantly increased risk in open fractures (relative risk = 2.2) [3]. Previous reports have suggested that the most common causes of ACS in the upper extremity in children are traumatic (e.g., supracondylar humerus fractures, bothbone forearm fractures) [1,2,11,21]. In our series, 15 patients (65 %) suffered traumatic injuries, with the majority being due to a fall from a height or a crush injury of the hand.…”

Section: Discussionmentioning

confidence: 99%

Acute compartment syndrome of the upper extremity in children: Diagnosis, management, and outcomes

Kanj

Gunderson

Carrigan

et al. 2013

Journal of Children's Orthopaedics

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Purpose Acute compartment syndrome (ACS) of the upper extremity is a rare but serious condition. The purpose of this study was to determine the etiology, diagnosis, treatment, and outcome of ACS of the upper extremity in a pediatric population. Methods We performed a retrospective chart review of all patients who underwent a decompressive fasciotomy for ACS of the upper extremity. Data collected included demographics, injury details, presenting symptoms, compartment measurements, time to diagnosis, time to treatment, and outcomes at the latest follow-up. Results Twenty-three children underwent fasciotomies for ACS of the forearm (15) and hand (8), at an average age of 9.3 years (range 0-17.8 years). The most common etiologies were fracture (13) and intravenous (IV) infiltration (3). The most common presenting symptoms were pain (83 %) and swelling (65 %). Compartment pressures were measured in 17/23 patients, and all but two patients had at least one compartment with a pressure [30 mmHg. The final two patients were diagnosed and treated for ACS based on clinical signs and symptoms. The average time from injury to fasciotomy was 32.8 h (3.7-158.0 h). Longterm outcome was excellent for 17 patients (74 %) and fair for 5 (22 %), based on the presence of loss of motor function, stiffness, or decreased sensation. One patient with brachial plexus injury and poor baseline function was excluded from functional outcome scoring. There was no association between the time from diagnosis to fasciotomy and functional outcome at the final follow-up (p = 1.000). Conclusions Although ACS of the upper extremity in children is often associated with a long delay between injury and fasciotomy, most children still achieve excellent outcomes. The majority of patients presented with pain and at least one additional symptom, but treatment was often delayed, implying that ACS of the upper extremity in children is a difficult diagnosis to establish and may be associated with a prolonged clinical time course.

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“…Fractures and fracture hematoma of the upper extremity, in particular those involving the elbow, forearm and wrist, have been reported as the most common causes of Compartment Syndrome in the pediatric population (Bae et al, 2001;Battaglia et al, 2002;Blakemore et al, 2000;Grottkau et al, 2005;Kadiyala & Waters, 1998;Kowtharapu et al, 2008;Krahn, 2005;Mubarak & Carroll, 1979;Paletta & Dehghan, 1994;Preis, 2000;Ramos et al, 2006;Yuan et al, 2004). Considering open vs closed forearm fractures the relative risk for developing a Compartment Syndrome is markedly increased in the open fracture group (Grottkau et al, 2005).…”

Section: Typical and Atypical Causes Of Forearm Compartment Syndromementioning

confidence: 99%

“…With early diagnosis and expeditious treatment being of key importance (Bae et al, 2001;Battaglia et al, 2002;Berger & Weiss, 2001;Bibbo et al, 2000;Blakemore et al, 2000;Choi et al, 2010;Christiansen et al, 1983;Cooney et al, 1980;Gousheh, 2010;Grottkau et al, 2005;Kadiyala & Waters, 1998;Kowtharapu et al, 2008;Krahn, 2005;Krenzien et al, 1998;Landi & Abate, 2010;Mars & Hadley,1998;Mubarak & Carroll, 1979;Ogden, 2000;Ouellette, 1998;Paletta & Dehghan, 1994;Prasarn et al, 2009;Prasarn & Ouellette, 2011;Preis 2000;Ragland et al, 2005;Ramos et al, 2006;Sawyer et al, 2010;Shin et al, 1996;Stott et al, 1997;Tachi et al, 2001;Yuan et al, 2004;Zhixin et al, 2010).…”

Section: Management and Treatment Of Compartment Syndromementioning

confidence: 99%

“…Incision lines should never cross skin folds perpendicular and never leave badly perfused flaps or skin margins behind (Berger & Weiss, 2001;Krenzien et al, 1998;Ogden, 2000). Splinting, elevation, and delayed wound closure usually follows the simple compartment fasciotomy (Bae et al, 2010;Battaglia et al, 2002;Blakemore et al, 2000;Choi et al, 2010;Cooney et al, 1980;Christiansen et al, 1983;Kowtharapu et al, 2008;Krahn, 2005;Landi & Abate, 2010;Mars & Hadley, 1998;Mubarak & Carroll, 1979;Ogden, 2000;Ouellette, 1998;Prasarn et al, 2009;Prasarn & Ouellette, 2011;Ragland et al, 2005;Ramos et al, 2006;Sawyer wt al, 2010;Shin et al, 1996;Stott et al, 1997;Zhixin et al, 2010).…”

Section: Management and Treatment Of Compartment Syndromementioning

confidence: 99%

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