Paediatric compartment syndrome: a retrospective analysis of outcomes

L Walker, B Mullins, C Edwards, F Wadia

University Hospital Southampton NHS trust

There is a paucity of evidence on the management of acute compartment syndrome (ACS) in the paediatric population with no published guidance regarding diagnostic criteria, indications for fasciotomy or on the long-term outcomes for patients with ACS. We present a retrospective cohort study reviewing all cases of paediatric ACS managed at a tertiary referral centre with the aim of characterising the factors responsible for the eventual outcomes.

The patient cohort was identified retrospectively by interrogating the hospital coding system for all paediatric patient codes as compartment syndrome between January 2014 and November 2022. The electronic emergency department, inpatient and operative notes as well as clinic letters for each patient were reviewed and data collected regarding presentation, associated injuries, management, and subsequent complications plus length of follow-up. The data was analysed to determine if differences in presentation or management affected long term outcome.

The final cohort consisted of 34 patients with a mean age of 10 years at the time of presentation. The mean time from presentation to fasciotomy was 27.6 hours (range 3.0 – 66.6). There was an overall complication rate of 37.5% with a mean follow-up period of 21 months. Patients who had primary closure of their fasciotomy wounds had a significantly lower complications rate and fewer operations compared to those who healed via other wound coverage methods or secondary intention (p <0.05).

Significantly lower complication rates were observed in patients who underwent primary/delayed primary wound closure following emergency fasciotomy compared to those with alternate methods of coverage. This finding may influence decision making regarding definitive fasciotomy wound management.