Skip to main content
SpringerLink
Log in

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

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

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). Long-term 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Blakemore LC, Cooperman DR, Thompson GH, Wathey C, Ballock RT (2000) Compartment syndrome in ipsilateral humerus and forearm fractures in children. Clin Orthop Relat Res 376:32–38

    Article  Google Scholar 

  2. Bae DS, Kadiyala RK, Waters PM (2001) Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop 21(5):680–688

    CAS  Google Scholar 

  3. Grottkau BE, Epps HR, Di Scala C (2005) Compartment syndrome in children and adolescents. J Pediatr Surg 40(4):678–682

    Article  Google Scholar 

  4. Prasarn ML, Ouellette EA, Livingstone A, Giuffrida AY (2009) Acute pediatric upper extremity compartment syndrome in the absence of fracture. J Pediatr Orthop 29(3):263–268

    Article  Google Scholar 

  5. Erdös J, Dlaska C, Szatmary P, Humenberger M, Vécsei V, Hajdu S (2011) Acute compartment syndrome in children: a case series in 24 patients and review of the literature. Int Orthop 35(4):569–575

    Article  Google Scholar 

  6. Kalyani BS, Fisher BE, Roberts CS, Giannoudis PV (2011) Compartment syndrome of the forearm: a systematic review. J Hand Surg Am 36(3):535–543

    Article  Google Scholar 

  7. Kadiyala RK, Waters PM (1998) Upper extremity pediatric compartment syndromes. Hand Clin 14(3):467–475

    CAS  Google Scholar 

  8. Ramos C, Whyte CM, Harris BH (2006) Nontraumatic compartment syndrome of the extremities in children. J Pediatr Surg 41(12):e5–e7

    Article  Google Scholar 

  9. Prasarn ML, Ouellette EA (2011) Acute compartment syndrome of the upper extremity. J Am Acad Orthop Surg 19(1):49–58

    Google Scholar 

  10. Heckman MM, Whitesides TE Jr, Grewe SR, Judd RL, Miller M, Lawrence JH 3rd (1993) Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma 7(3):199–210

    Article  CAS  Google Scholar 

  11. Whitesides TE, Heckman MM (1996) Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg 4(4):209–218

    Google Scholar 

  12. Dente CJ, Feliciano DV, Rozycki GS, Cava RA, Ingram WL, Salomone JP, Nicholas JM, Kanakasundaram D, Ansley JP (2004) A review of upper extremity fasciotomies in a level I trauma center. Am Surg 70(12):1088–1093

    Google Scholar 

  13. Flynn JM, Bashyal RK, Yeger-McKeever M, Garner MR, Launay F, Sponseller PD (2011) Acute traumatic compartment syndrome of the leg in children: diagnosis and outcome. J Bone Joint Surg Am 93(10):937–941

    Article  Google Scholar 

  14. Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA (1986) Compartment syndrome in open tibial fractures. J Bone Joint Surg Am 68(9):1348–1353

    CAS  Google Scholar 

  15. McQueen MM, Court-Brown CM (1996) Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 78(1):99–104

    CAS  Google Scholar 

  16. Matsen FA 3rd (1980) Compartmental syndromes. Hosp Pract 15(2):113–117

    Google Scholar 

  17. Kowtharapu DN, Thabet AM, Holmes L Jr, Kruse R (2008) Osteochondral flap avulsion fracture in a child with forearm compartment syndrome. Orthopedics 31(8):805

    Article  Google Scholar 

  18. Mai MC, Beck R, Gabriel K, Singh KA (2011) Posterior arm compartment syndrome after a combined supracondylar humeral and capitellar fractures in an adolescent: a case report. J Pediatr Orthop 31(3):e16–e19

    Article  Google Scholar 

  19. Pettitt DA, McArthur P (2011) A boy with a painful arm. BMJ 342:c5972

    Article  CAS  Google Scholar 

  20. Mubarak SJ, Carroll NC (1979) Volkmann’s contracture in children: aetiology and prevention. J Bone Joint Surg Br 61-B(3):285–293

    CAS  Google Scholar 

  21. McQueen MM, Gaston P, Court-Brown CM (2000) Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br 82(2):200–203

    Article  CAS  Google Scholar 

  22. Sheffler LC, Lattanza L, Hagar Y, Bagley A, James MA (2012) The prevalence, rate of progression, and treatment of elbow flexion contracture in children with brachial plexus birth palsy. J Bone Joint Surg Am 94(5):403–409

    Article  Google Scholar 

  23. Finkelstein JA, Hunter GA, Hu RW (1996) Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma 40(3):342–344

    Article  CAS  Google Scholar 

Download references

Conflict of interest

No outside funding was used for this investigation. The authors have no conflicts of interest to report with respect to this investigation.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., 2nd Floor Wood Building, Philadelphia, PA, 19104, USA

    Wajdi W. Kanj, Melissa A. Gunderson, Robert B. Carrigan & Wudbhav N. Sankar

Authors
  1. Wajdi W. Kanj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa A. Gunderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert B. Carrigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wudbhav N. Sankar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wudbhav N. Sankar.

Additional information

This study was performed at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA.

This was an IRB-approved study.

About this article

Cite this article

Kanj, W.W., Gunderson, M.A., Carrigan, R.B. et al. Acute compartment syndrome of the upper extremity in children: diagnosis, management, and outcomes. J Child Orthop 7, 225–233 (2013). https://doi.org/10.1007/s11832-013-0492-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-013-0492-9

Keywords

Search

Navigation