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Risk factors for developing acute compartment syndrome in the pediatric population: a systematic review and meta-analysis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Acute compartment syndrome (ACS) is often difficult to diagnose in pediatric patients due to their erratic symptomatology. Therefore, it is of paramount importance to identify at-risk patients to facilitate a prompt diagnosis. This study aims to identify risk factors for the development of ACS in the pediatric population.

Methods

We included studies comprised of pediatric patients with traumatic ACS. We excluded studies evaluating compartment syndrome secondary to exertion, vascular insult, abdominal processes, burns, and snake bites. Heterogeneity was addressed by subgroup analysis, and whenever it remained significant, we utilized a random-effects meta-analysis for data pooling. The protocol has been registered at PROSPERO (ID = CRD42019126603).

Results

We included nine studies with 380,411 patients, of which 1144 patients were diagnosed with traumatic ACS. The average age was 10 years old, and 67% of patients were male. Factors that were significantly associated with ACS were: open radius/ulna fractures (OR 3.56 CI 1.52–8.33, p = 0.003), high-energy trauma (OR 3.51 CI 1.71–7.21, p = 0.001), humerus fractures occurring concurrently with forearm fractures (OR 3.49 CI 1.87–6.52, p < 0.001), open tibia fractures (OR 2.29 CI 1.47–3.55, p < 0.001), and male gender (OR 2.06 CI 1.70–2.51, p < 0.001).

Conclusion

In the present study, open fractures, high-energy trauma, concurrent humerus and forearm fractures, and male gender significantly increased the risk of developing ACS in the pediatric population. Clinicians should raise their suspicion for ACS when one or multiple of these factors are present in the right clinical context.

Type of study

Systematic review and meta-analysis.

Level of evidence

III.

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Funding

No funding was received for this study.

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Author notes

  1. Sharri J. Mortensen and Sebastian Orman have contributed equally as first authors.

  2. Ara Nazarian and Arvind G. von Keudell have contributed equally as senior authors.

Authors and Affiliations

  1. Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA

    Sharri J. Mortensen, Amin Mohamadi & Ara Nazarian

  2. Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Sebastian Orman & Edward J. Testa

  3. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Arvind G. von Keudell

  4. Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA

    Ara Nazarian & Arvind G. von Keudell

  5. Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia

    Ara Nazarian

Authors
  1. Sharri J. Mortensen
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  2. Sebastian Orman
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  6. Arvind G. von Keudell
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Correspondence to Sharri J. Mortensen.

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Mortensen, S.J., Orman, S., Testa, E.J. et al. Risk factors for developing acute compartment syndrome in the pediatric population: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 30, 839–844 (2020). https://doi.org/10.1007/s00590-020-02643-0

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  • DOI: https://doi.org/10.1007/s00590-020-02643-0

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