Who Gets Compartment Syndrome?: A Retrospective Analysis of the National and Local Incidence of Compartment Syndrome in Patients With Supracondylar Humerus Fractures

Robertson, Alysia K; Snow, Erica E.; Browne, Theodora; Brownell, Sha'Tia; Inneh, Ifeoma A.; Hill, Jaclyn F.

doi:10.1097/bpo.0000000000001144

Cited by 31 publications

(37 citation statements)

References 8 publications

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“…Robertson et al showed that neurovascular injuries and older age were both risk factors for developing compartment syndrome in children with grade III supracondylar fractures, as in this case. 18 Sinikumpu et al performed a population-based long-term followup study of 81 children with Gartland I-III fractures; of these, 25 were Gartland III fractures and they found that only 76% of these had a satisfactory outcome after closed or open reduction and percutaneous pinning according to Flynn's criteria. 19 The current study was looking only at Gartland III fractures (38 cases) and also found that although most patients at 24 weeks had return of full ROM, they had reduced scores using the PODCI in over 30% of cases.…”

Section: Discussionmentioning

confidence: 99%

Assessment of elbow functional outcome after closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children

Rutarama

Firth

2019

SA orthop. j.

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Background: The aim of the current study was to establish the functional outcome of Gartland grade III extension-type supracondylar fractures at 24 weeks after closed reduction and percutaneous pinning (CRPP) without physiotherapy. The objectives of this study were 1) to measure the elbow range of motion (ROM) at three, six, 12 and 24 weeks after CRPP for grade III supracondylar fractures; 2) to assess the functional outcome of the injured limb using the Paediatric Outcome Data Collection Instrument (PODCI) score; 3) to compare elbow functional outcome of children less than 7 years old versus children more than 7 years old; and 4) to assess other risk factors or complications associated with poor outcomes after CRPP (including age and associated soft tissue injury). Patients and methods: A prospective cohort study was performed. The study included 38 children under the age of 14 years with grade III extension-type supracondylar fractures who had manipulation under anaesthesia (MUA) and crossed K-wire fixation. ROM of the affected elbow (flexion, extension, pronation and supination) was measured at three, six, 12 and 24 weeks after CRPP by the same author (AR) at each visit. The unaffected elbow was used as a control. The PODCI was also recorded. No physiotherapy was prescribed. Results: Thirty-eight children were included in the study. All components of elbow ROM improved at 24 weeks (p<0.001). At 12 but not 24 weeks, the mean elbow extension was reduced in comparison with the controls (p=0.009). Patients less than 7 years of age recovered extension more rapidly (p=0.001). Seventy-six per cent of the children achieved satisfactory PODCI results at the 24-week final follow-up. Nerve palsy (18.4%) and severe soft tissue injuries (7.9%) were the main contributory factors to a poor outcome on the PODCI assessment. Conclusion: The majority of children with displaced supracondylar fractures recover full ROM after CRPP by 24 weeks without physiotherapy. Older children, or those with associated neurovascular and soft tissue injuries had poor functional outcomes. Further studies are needed to assess if these patients will benefit from physiotherapy.

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Section: Discussionmentioning

confidence: 99%

Assessment of elbow functional outcome after closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children

Rutarama

Firth

2019

SA orthop. j.

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“…In an effort to identify the incidence and risk factors for PACS related to supracondylar humerus factures a retrospective review of data from a Level I pediatric trauma center and the National Trauma Data Bank was conducted by Robertson and colleagues. 6 These investigators found the incidence of PACS to be approximately 2 to 3 per 1,000 fractures. Additionally, they found that associated neurovascular injury increased the risk of ACS to 4.5%.…”

Section: Risk Factors Leading To Acsmentioning

confidence: 97%

“…The following conditions have been identified in the literature as causative factors in the development of PACS: fractures, vascular insult, surgical positioning, constricting casts or wraps, leukemia, intravenous infiltration, overexertion, snake and insect bites, neonatal context, and infection. [6][7][8][9][10][11][12][13][14] when fascial compartments cannot accommodate muscle expansion during exercise, resulting in tissue ischemia. Neonatal compartment syndrome is a rare occurrence and has only been reported in the upper extremities.…”

Section: Etiology Of Acsmentioning

confidence: 99%

“…The national incidence of compartment syndrome with supracondylar humerus fractures is 0.2%. 6 The incidence of compartment syndrome increases to 0.8% in patients who in addition to a supracondylar humerus fracture also sustain a forearm fracture, a condition known as floating elbow. ACS has been reported in all extremities, with the lower leg being the most common site (60%), usually associated with tibial fractures, followed by the forearm (27%).…”

Section: Acs With Upper and Lower Extremity Fracturesmentioning

confidence: 99%

“…Other identified risk factors included male gender (76% vs 24%) and older patients (7.3 years vs. 5.5 years). 6 Heath care practitioners should maintain a high index of suspicion for PACS with trauma to an extremity. The incidence of PACS increases with an associated fracture.…”

Section: Risk Factors Leading To Acsmentioning

confidence: 99%

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