Diesselhorst Matthew M, Deck Jason W, Davey Joseph P
Departments of *Orthopedic Surgery and Rehabilitation †Family Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK.
J Pediatr Orthop. 2014 Mar;34(2):e1-4. doi: 10.1097/BPO.0b013e3182933c69.
Supracondylar fractures of the humerus are the most frequently seen elbow fractures in children. One of the most feared complications of this fracture, that is, compartment syndrome of the forearm is seen rarely. Compartment syndrome of the upper arm is an even more rare occurrence and to date, has not been reported in association with an isolated supracondylar humerus fracture in a child.
A 9-year-old boy was cared for at our facility for a severe (Gartland type III) supracondylar humerus fracture and developed a compartment syndrome in the perioperative period. A clinical, radiographic, and literature review of this case was undertaken to better define this occurrence.
This patient sustained a closed supracondylar humerus fracture in association with a motor and sensory deficit of the radial nerve. Because of the severity of the deformity, a provisional reduction was performed in the emergency department. Eleven hours after the injury, a routine closed reduction and percutaneous pinning was performed. Although significant swelling was noted at that time, compartment syndrome was not clinically suspected. He was observed as an inpatient because of this persistent swelling. Over the next day, he developed considerable tenderness over the anterior arm and mobile wad musculature, hence, compartment pressure measurements were made. These confirmed a compartment syndrome in the anterior compartment of the arm and equivocally in the mobile wad. An urgent compartment release of the arm was done, which resulted in full recovery.
This is the first report of a compartment syndrome of the arm after an isolated supracondylar humerus fracture in a child. The presence of the associated fracture made the classic signs of compartment syndrome difficult to assess. Ultimately, muscle tenderness and compartment pressure measurement were most helpful in making this diagnosis. A high index of suspicion should be maintained for compartment syndrome of the arm as well as the forearm when evaluating children with severe supracondylar humerus fractures.
Level IV, case report.
肱骨髁上骨折是儿童最常见的肘部骨折。这种骨折最令人担忧的并发症之一，即前臂骨筋膜室综合征很少见。上臂骨筋膜室综合征更为罕见，迄今为止，尚未见有与儿童孤立性肱骨髁上骨折相关的报道。
一名9岁男孩因严重（Gartland III型）肱骨髁上骨折在我们的机构接受治疗，并在围手术期发生了骨筋膜室综合征。对该病例进行了临床、影像学和文献回顾，以更好地明确这一情况。
该患者发生闭合性肱骨髁上骨折，并伴有桡神经运动和感觉功能障碍。由于畸形严重，在急诊科进行了临时复位。受伤11小时后，进行了常规闭合复位和经皮穿针固定。尽管当时发现有明显肿胀，但临床上未怀疑骨筋膜室综合征。因其持续肿胀，作为住院患者进行观察。在接下来的一天里，他在前臂和肱桡肌出现了相当程度的压痛，因此进行了骨筋膜室压力测量。结果证实上臂前侧骨筋膜室存在骨筋膜室综合征，肱桡肌处情况不明确。紧急进行了上臂骨筋膜室切开减压术，患者完全康复。
这是首例关于儿童孤立性肱骨髁上骨折后上臂骨筋膜室综合征的报道。合并骨折的存在使得骨筋膜室综合征的典型体征难以评估。最终，肌肉压痛和骨筋膜室压力测量对做出这一诊断最有帮助。在评估患有严重肱骨髁上骨折的儿童时，应高度怀疑上臂以及前臂发生骨筋膜室综合征。
IV级，病例报告。
