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Mini approaches fasciotomy combined with vacuum sealing drainage for acute compartment syndrome caused by fractures in children

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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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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Thanks are due to Hanjun Wu in our Medical Record Department for data collection and all staffs in Orthopedic Department performing the surgeries.

Author information

Author notes

  1. Jingwen Yan

    Present address: Department of Clinical Medicine, Xiangya School of Medicine of Central South University, Changsha, China

Authors and Affiliations

  1. Orthopedics Department, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Jie Hu, Jingwen Yan & Yuxi Su

  2. Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China

    Jie Hu, Jingwen Yan & Yuxi Su

  3. National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China

    Jie Hu, Jingwen Yan & Yuxi Su

  4. Jiangxi Hospital Affiliated Children’s Hospital of Chongqing Medical University, Nanchang, China

    Jie Hu, Jingwen Yan & Yuxi Su

  5. Orthopedics Department, Chengdu Women’s and Children’s Central Hospital, Chengdu, Sichuan, China

    Jie Hu

Authors
  1. Jie Hu
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Contributions

YX conceived the study, participated in its design, and drafted the manuscript. JZ helped in collecting the clinical data and help drafted the manuscript. JY drew the schematic diagram and performed the statistical analysis and helped draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuxi Su.

Ethics declarations

Ethics approval and consent to participate

Children’s parents or the guardians signed the informed consent and approved the use of clinical data of their children. Children’s hospital of Chongqing Medical University’s ethics committee approved the study.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Jie Hu and Jingwen Yan contributed equal to this study.

Level of evidence: IV

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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 (SICOT) (2023). https://doi.org/10.1007/s00264-023-05984-7

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