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Pediatric Acute Compartment Syndrome

Livingston, Kristin S. MD; Glotzbecker, Michael P. MD; Shore, Benjamin J. MD, MPH, FRCSC

Journal of the American Academy of Orthopaedic Surgeons: May 2017 - Volume 25 - Issue 5 - p 358–364
doi: 10.5435/JAAOS-D-15-00655
Review Article

Pediatric acute compartment syndrome (PACS) is a clinical entity that must be carefully differentiated from the adult version (ie, acute compartment syndrome). Healthcare providers must understand the variable etiologies of PACS, of which trauma is the most common but can also include vascular insult, infection, surgical positioning, neonatal phenomena, overexertion, and snake and insect bites. In addition to the unique etiologies of PACS, providers must also recognize the different signs and symptoms of PACS. The three As (ie, anxiety, agitation, analgesic requirement) of PACS have supplanted the classic adult signs as being more accurate and allowing earlier detection. In children with questionable clinical signs but concern for PACS, compartment pressure measurement may be necessary to confirm the diagnosis. Overall, outcomes after fasciotomy in children tend to be excellent; however, diagnostic delays secondary to unfamiliar clinical scenarios can lead to myonecrosis and subsequent poor outcomes.

From the Department of Orthopaedic Surgery, University of California San Francisco School of Medicine, San Francisco, CA (Dr. Livingston) and the Department of Orthopaedic Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, MA (Dr. Glotzbecker and Dr. Shore).

Dr. Glotzbecker or an immediate family member serves as a paid consultant to DePuy Synthes and Medtronic, and has received research or institutional support from DePuy Synthes and the Chest Wall and Spine Deformity Study Group. Dr. Shore or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy for Cerebral Palsy and Developmental Medicine and the Pediatric Orthopaedic Society of North America. Neither Dr. Livingston nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Received November 09, 2015

Accepted May 12, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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