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Pediatric Nonfracture Acute Compartment Syndrome: A Review of 39 Cases

Livingston, Kristin MD; Glotzbecker, Michael MD; Miller, Patricia E. MS; Hresko, Michael T. MD; Hedequist, Daniel MD; Shore, Benjamin J. MD, MPH, FRCSC

doi: 10.1097/BPO.0000000000000526

Background: Compartment syndrome in the absence of fracture is rare and poorly described within the pediatric literature. The purpose of this study was to report the varying etiologies, risk factors, and treatment outcomes associated with pediatric nonfracture acute compartment syndrome (NFACS).

Methods: We conducted a retrospective chart review on 37 children who suffered a NFACS and were treated at a single pediatric trauma center between 1997 and 2013. Demographic, diagnostic, treatment, and outcome characteristics were reviewed. Five causal groups were generated: trauma, exercise related (acute presentation after exercise without trauma), infectious, vascular, and postoperative (in the absence of osteotomy). Univariate and multivariate analyses were performed to identify risk factors of NFACS. P-values <0.05 were considered statistically significant.

Results: There were 39 cases of NFRCS in 37 children [6 females, 31 males, mean age of 11.7 y (SD+7.2 y)]. The leg was the most commonly involved limb (29 cases, 74%). Diagnosis of NFRCS was made either by compartment pressure monitoring [59%, 23/39 cases, mean pressure 66 mm Hg (SD+28)] or by clinical examination. According to etiology, vascular was most common (11/39, 28%), followed by trauma (10/39, 26%) and postoperative (8/39, 21%), with exertion and infection representing a small proportion (6/39, 15% and 4/39, 10%, respectively). Pain was present in 33 cases (85%), swelling in 28 cases (72%), paresthesias in 13 cases (33%), motor deficit in 12 cases (31%), and poor perfusion in 11 cases (28%). Average time from symptom onset to diagnosis was 48 hours (IQR, 9 to 96 h). At surgery, 21 patients (54%) had evidence of myonecrosis. Children required an average of 3 surgeries for wound closure. The median time to follow-up was 232 days (IQR, 73 to 608 d). A total of 54% made a full recovery, whereas 31% suffered a persistent neurological or functional deficit.

Conclusions: NFACS in children is associated with a delay in diagnosis and a high rate of myonecrosis. Timely assessment with high clinical suspicion is necessary to prevent a delay in diagnosis.

Level of evidence: Level IV.

Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA

No sources of support. No funding to disclose.

The authors declare no conflicts of interest.

Reprints: Benjamin J. Shore, MD, MPH, FRCSC, Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Hunnewell 221, 300 Longwood Avenue, Boston, MA 02115. E-mail:

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