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Acute Compartment Syndrome in Children: Contemporary Diagnosis, Treatment, and Outcome

Bae, Donald S. M.D.*; Kadiyala, R. Kumar M.D., Ph.D.; Waters, Peter M. M.D.

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Compartment syndrome can be difficult to diagnose in a child, with delays in diagnosis leading to disastrous outcomes. Thirty-six cases of compartment syndrome in 33 pediatric patients were treated at the authors' institution from January 1, 1992, to December 31, 1997. There were 27 boys and 6 girls, with nearly equal upper and lower extremity involvement. Approximately 75% of these patients developed compartment syndrome in the setting of fracture. Pain, pallor, paresthesia, paralysis, and pulselessness were relatively unreliable signs and symptoms of compartment syndrome in these children. An increasing analgesia requirement in combination with other clinical signs, however, was a more sensitive indicator of compartment syndrome: all 10 patients with access to patient-controlled or nurse-administered analgesia during their initial evaluation demonstrated an increasing requirement for pain medication. With early diagnosis and expeditious treatment, >90% of the patients studied achieved full restoration of function.

Study conducted at The Children's Hospital, Boston, Massachusetts, U.S.A.

From *The Harvard Combined Residency Program, Massachusetts General Hospital, Boston, Massachusetts; the †Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and ‡The Children's Hospital, Boston, Massachusetts, U.S.A.

Address correspondence and reprint requests to Dr. Peter M. Waters, Dept. of Orthopaedic Surgery, The Children's Hospital, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115, U.S.A. (e-mail: peter.waters@tch.harvard.edu).

© 2001 Lippincott Williams & Wilkins, Inc.