School of Medicine and Health Sciences Poster Presentations
Risk Factors for Compartment Syndrome in Treatment of Supracondylar Humerus Fractures
Poster Number
209
Document Type
Poster
Publication Date
3-2016
Abstract
Purpose: Ischemia secondary to vascular injury or compartment syndrome (CS) potentially complicates management of supracondylar humerus (SCH) fractures. Prompt recognition and treatment prevents irreversible muscle damage. We aimed to determine risk factors associated with the development of CS in patients with SCH fractures.
Methods: A retrospective chart review was performed of all patients surgically treated for displaced Gartland Type III SCH fractures from 2007-2014 at a single tertiary care pediatric hospital. Baseline demographics included age, injury type (open vs. closed), and mechanism of injury. Vascular status, defined by presence or absence of a palpable pulse and hand perfusion, was recorded at all time-points through care, along with existence of neurologic deficit. Multiple pre-, intra-, and post-operative variables were gathered and two groups, CS and non-CS, were compared. The data was analyzed with a two-tail significance level of 0.05 to determine risk factors contributing to the development of CS.
Results: Of the 733 patients included, 7 (0.95%) developed CS requiring fasciotomy. Three patients presented acutely, three patients in the early postoperative period, and one patient in a delayed fashion. Open fractures occurred at a higher frequency in the CS group compared to non-CS group (2 vs 9, p=0.004). Patient and fracture demographics were similar between the groups. Time to surgery had no effect on the outcome. The mean operative time was greater in patients who developed CS than those who did not (89.1 min vs 40.5 min, p=0.0051); however, 5 of 7 patients had concomitant procedures including fracture debridement or fasciotomy at the time of reduction. Vascular status and nerve injury were not significant risk factors associated with CS.
Conclusion: Previous research identified the clinical finding of a pulseless hand as a risk factor for vascular injury and associated complications. Our study suggests that an open fracture pattern may represent another feature with a higher risk of developing CS, potentially related to degree of initial soft tissue trauma. Increased operative time observed in our CS group was likely related to surgical complexity and need for associated procedures as opposed to prolonged traction or manipulation necessary to achieve fracture reduction.
Significance: CS is a rare but potentially devastating complication occurring in patients with SCH fractures. Identification and close observation of patients with specific clinical indicators fated for a poorer outcome may improve early detection and treatment of CS and prevention of long-term sequelae. Awareness that symptoms of ischemia warranting treatment can evolve prior to fracture stabilization, during the early postoperative period or in a delayed fashion is important for proper diagnosis.
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Open Access
1
Risk Factors for Compartment Syndrome in Treatment of Supracondylar Humerus Fractures
Purpose: Ischemia secondary to vascular injury or compartment syndrome (CS) potentially complicates management of supracondylar humerus (SCH) fractures. Prompt recognition and treatment prevents irreversible muscle damage. We aimed to determine risk factors associated with the development of CS in patients with SCH fractures.
Methods: A retrospective chart review was performed of all patients surgically treated for displaced Gartland Type III SCH fractures from 2007-2014 at a single tertiary care pediatric hospital. Baseline demographics included age, injury type (open vs. closed), and mechanism of injury. Vascular status, defined by presence or absence of a palpable pulse and hand perfusion, was recorded at all time-points through care, along with existence of neurologic deficit. Multiple pre-, intra-, and post-operative variables were gathered and two groups, CS and non-CS, were compared. The data was analyzed with a two-tail significance level of 0.05 to determine risk factors contributing to the development of CS.
Results: Of the 733 patients included, 7 (0.95%) developed CS requiring fasciotomy. Three patients presented acutely, three patients in the early postoperative period, and one patient in a delayed fashion. Open fractures occurred at a higher frequency in the CS group compared to non-CS group (2 vs 9, p=0.004). Patient and fracture demographics were similar between the groups. Time to surgery had no effect on the outcome. The mean operative time was greater in patients who developed CS than those who did not (89.1 min vs 40.5 min, p=0.0051); however, 5 of 7 patients had concomitant procedures including fracture debridement or fasciotomy at the time of reduction. Vascular status and nerve injury were not significant risk factors associated with CS.
Conclusion: Previous research identified the clinical finding of a pulseless hand as a risk factor for vascular injury and associated complications. Our study suggests that an open fracture pattern may represent another feature with a higher risk of developing CS, potentially related to degree of initial soft tissue trauma. Increased operative time observed in our CS group was likely related to surgical complexity and need for associated procedures as opposed to prolonged traction or manipulation necessary to achieve fracture reduction.
Significance: CS is a rare but potentially devastating complication occurring in patients with SCH fractures. Identification and close observation of patients with specific clinical indicators fated for a poorer outcome may improve early detection and treatment of CS and prevention of long-term sequelae. Awareness that symptoms of ischemia warranting treatment can evolve prior to fracture stabilization, during the early postoperative period or in a delayed fashion is important for proper diagnosis.
Comments
Presented at: GW Research Days 2016