O3093 ACUTE COMPARTMENT SYNDROMES (ACS) IN CHILDREN

Abstract

Aims: Etiology, diagnosis, treatment and long-term defects after acute compartment syndromes (ACS) in adults have been well documented. However, very few studies are available about ACS in children. Purpose of this metaanalysis was to evaluate frequency, diagnostic, therapeutic and prognostic characteristics of ACS in pediatric patients. Methods: Thirteen relevant international studies with a total number of 171 patients aged 16 or less was analysed in terms of etiology, clinical and diagnostic aspects, role of monitoring of the intra-compartmental pressure (ICP), treatment and outcome. Results: 40% of ACS occurred as direct or indirect result of a fracture or osteotomy, most commonly seen as complication after cutaneous or BryantÔs traction in pediatric femur fractures, followed by supra-condylar fractures of the humerus and fractures of tibia or forearm. Clinical characteristics were pain, tenderness, stretching pain and neu-rological defects. ICP was measured in 25%. Dermatofasciotomy was performed in 50.3%. In 4.3% the lower leg had to be amputated. In only 35.3% of the children no neurovascular defect could be observed, whereas defects were rated as mild in 11.2%, moderate in 11.2% and severe in 42.3%. The time period between onset of symptoms and adequate diagnosis and treatment was crucial for complete recovery. Decreased bone growth and deformities were described as long-term complications. Conclusions: Since the expected functional defect rate after ACS in children is as high as 64.7%, a high index of suspicion is crucial for successful management, based on early dermatofasciotomy after reliable diagnostics.