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Acute Traumatic Compartment Syndrome of the Leg in Children: Diagnosis and Outcome

(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)

PRESENTED BY

WINDI PERTIWI 20070310128


SUPERVISING DOCTOR

DR. L. HARTOKO B.,SP.OT

COMPARTMENT SYNDROME
Compartment syndrome represent elevated compartment pressures within a soft tissue envelope of an extremity and commonly follows significant trauma and increased pressures lead to ischemia and may lead to irreversible injury to muscle and nerve.

E T I O L O G Y

PATHOPHYSIOLOGY

CLINICAL FINDING
The classic features of ischaemia are the five Ps: Pain Paraesthesia Pallor Paralysis Pulselessness.

DIAGNOSIS
Diagnosis of compartment syndrome can be made by the clinical finding and the confirmation of the diagnosis can be made by measuring the intracompartmental pressures.

TREATMENT
The threatened compartment (or compartments) must be promptly

decompressed. 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 four compartments 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.

ACUTE TRAUMATIC COMPARTMENT SYNDROME of the LEG in CHILDREN : DIAGNOSIS and TREATMENT

BACKGROUND
The most common clinical case for compartment syndrome in children is acute compartment syndrome in the leg

METHODS
43 cases of acute traumatic syndrome collected over 17 year

period. 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, and outcome at the time of the latest follow-up were recorded

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 ipsilateral femoral fracture, and two (5%) sustained a gunshot wound with no fracture.

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 thirtythree (77%) of the forty-three cases. In all thirty-three cases, intracompartmental pressures of>30 mm Hg were measured in at least one compartment.

DISCUSSION
In this research, all patients underwent fasciotomy There were no cases of infection. All patients who had fasciotomy within 27 hours after the

injury had full functional recovery at the time of the latest follow-up, In summary, acute traumatic compartment syndrome of the leg in the skeletally immature patient is an acute surgical emergency that demands prompt fasciotomy on diagnosis. And good results can be achieved even when fasciotomy is performed in the acute swelling phase, often twenty-four to forty-eight hours after the initial injury in pediatric patients.

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