ACUTE POST-TRAUMATIC COMPARTMENT SYNDROME OF THE LEG IN CHILDREN

Abstract

Purpose: Since the advent of pinning for supracondylar fractures of the humerus, Volkmann syndrome has been exceptional and most of the posttraumatic compartment syndromes observed in children have been seen in the lower limb. We propose an analysis of the causes, the diagnosis, the treatment and the results of treatment of acute posttraumatic compartment syndrome of the leg in children.

Material and methods: Twenty-eight consecutive cases of acute posttraumatic compartment syndrome in 27 children were reviewed. These children were treated in two American paediatric traumatology units over a ten year period. We evaluated the cause of the trauma, associated lesions, clinical course, diagnostic methods, muscle compartment pressures, time from accident to diagnosis, and time from accident to surgery. Results were analysed at last follow-up.

Results: The study population was 24 boys and three girls, aged 4 months to 15 years. Twenty-four children were pedestrian traffic accident victims. Twenty-two had a tibial fracture, four a femoral fracture, and two no fracture. Twenty-five compartment syndromes were diagnosed on the basis of compartment pressure measurements. Mean time from accident to diagnosis was 19 hours (range 2.5–85 hr). At diagnosis, exacerbated pain was observed in 26 children, paraesthesia in eleven, motor deficit in seven, and diminished pulses in three. Mean time from accident to surgery was 21 hours. Mean follow-up was 15 months. The final outcome was remarkably good. At last follow-up, 24 children were pain free, with no functional or sensorial deficit. Aponeurotomy had been performed very late (43, 83, and 86 hr) in the three patients who developed functional deficit. There were no cases of infection even when surgery was performed late.

Discussion: Most children treated for acute posttraumatic compartment syndrome achieve a good result even when the time from accident to treatment is long, often more than 12 hours. All patients with sequellae at the last follow-up in our series had undergone aponeurotomy more than 36 hours after the accident.

Conclusion: This is the first series devoted exclusively to acute posttraumatic compartment syndrome of the leg in children. The results were generally good despite significant time from accident to treatment.