acute traumatic compartment syndrome of the
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P R E S E N T E D B Y
W I N D I P E R T I W I2 0 0 7 0 3 1 0 1 2 8
S U P E R V I S I N G D O C T O R
D R . L . H A R T O K O B . , S P . O T
Acute Traumatic CompartmentSyndrome of the
Leg in Children: Diagnosis andOutcome
(M. Flynn, MD, Ravi K. Bashyal, MD, Meira Yeger-McKeever, MD, Matthew R. Garner, MD,
Franck Launay, MD, and Paul D ; THE JOURNAL OF BONE AND JOINT SURGERY, 2011)
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COMPARTMENT SYNDROME
Compartment syndrome represent elevatedcompartment pressures within a soft tissue envelopeof an extremity and commonly follows significant
trauma and increased pressures lead to ischemia andmay lead to irreversible injury to muscle and nerve.
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E
T
IO
L
OG
Y
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PATHOPHYSIOLOGY
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CLINICAL FINDING
The classic features of ischaemia are the five Ps:
Pain
Paraesthesia
Pallor Paralysis
Pulselessness.
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DIAGNOSIS
Diagnosis of compartment syndrome can be made by theclinical finding and the confirmation of the diagnosis can bemade by measuring the intracompartmental pressures.
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TREATMENT
The threatened compartment (or compartments) must be promptlydecompressed.
The P should be carefully monitored; if its less than 30 mmHg,immediate open fasciotomy is performed.
In the case of the leg, fasciotomy means opening all fourcompartments through medial and lateral incisions.
The wounds should be left open and inspected 2 days later:
a. if there is muscle necrosis, debridement can be carried out;
b.If the tissues are healthy, the wounds can be sutured(without tension)
or skin-grafted.
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ACUTE TRAUMATIC COMPARTMENT SYNDROMEof the LEG in CHILDREN : DIAGNOSIS and
TREATMENT
BACKGROUND
The most common clinical case for compartment syndrome inchildren is acute compartment syndrome in the leg
METHODS
43 cases of acute traumatic syndrome collected over 17 yearperiod. All children with acute traumatic compartment
syndrome underwent fasciotomy. The mechanism of injury, date and time of injury, time to
diagnosis, compartment pressures, time to fasciotomy, andoutcome at the time of the latest follow-up were recorded
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42 patients and all were treated with fasciotomy. The study group included 37 male and 5 female patients
ranging in age from 4 months to 17 years old.
Thirty-five (83%) of the forty-two patients presented
following a motor-vehicle accident Thirtyfive (83%) of the forty-two patients sustained an
ipsilateral tibial fracture, five (12%) sustained an ipsilateralfemoral fracture, and two (5%) sustained a gunshot wound
with no fracture.
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Symptoms at the time of diagnosis varied.
a. Increasing leg pain was noted in forty cases(93%) ,
b. paresthesias were noted in eleven cases (26%),
c. muscle weakness was noted in seven cases (16%),
d. absent or diminished pulses were noted in six cases (14%).
Compartment pressures were measured prior to fasciotomy in thirty-three (77%) of the forty-three cases. In all thirty-three cases,intracompartmental pressures of>30 mm Hg were measured in at least
one compartment.
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DISCUSSION
In this research, all patients underwent fasciotomy
There were no cases of infection.
All patients who had fasciotomy within 27 hours after theinjury had full functional recovery at the time of the latestfollow-up,
In summary, acute traumatic compartment syndrome ofthe leg in the skeletally immature patient is an acutesurgical emergency that demands prompt fasciotomy on
diagnosis.
And good results can be achieved even when fasciotomy isperformed in the acute swelling phase, often twenty-four toforty-eight hours after the initial injury in pediatric
patients.
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