Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Surg Res. 2024 Jun;298:53-62. doi: 10.1016/j.jss.2024.01.032. Epub 2024 Apr 2.
There is a paucity of large-scale data on the factors that suggest an impending or underlying extremity pediatric acute compartment syndrome (ACS). In addition, literature regarding the timing of operative fixation and the risk of ACS is mixed. We aimed to describe the factors associated with pediatric ACS.
Analysis of 2017-2019 Trauma Quality Improvement Program. We included patients aged <18 y diagnosed with upper extremity (UE) and lower extremity (LE) fractures. Burns and insect bites/stings were excluded. Multivariable regression analyses were performed to identify the predictors of ACS.
61,537 had LE fractures, of which 0.5% developed ACS. 76,216 had UE fractures, of which 0.16% developed ACS. Multivariable regression analyses identified increasing age, male gender, motorcycle collision, and pedestrian struck mechanisms of injury, comminuted and open fractures, tibial and concurrent tibial and fibular fractures, forearm fractures, and operative fixation as predictors of ACS (P value <0.05). Among LE fractures, 34% underwent open reduction internal fixation (time to operation = 14 [8-20] hours), and 2.1% underwent ExFix (time to operation = 9 [4-17] hours). Among UE fractures, 54% underwent open reduction internal fixation (time to operation = 11 [6-16] hours), and 1.9% underwent ExFix (time to operation = 9 [4-14] hours). Every hour delay in operative fixation of UE and LE fractures was associated with a 0.4% increase in the adjusted odds of ACS (P value <0.05).
Our results may aid clinicians in recognizing children who are "at risk" for ACS. Future studies are warranted to explore the optimal timing for the operative fixation of long bone fractures to minimize the risk of pediatric ACS.
目前关于提示或潜在四肢儿科急性骨筋膜室综合征（ACS）即将发生的因素的大规模数据很少。此外，关于手术固定时机和 ACS 风险的文献存在差异。我们旨在描述与儿科 ACS 相关的因素。
对 2017-2019 年创伤质量改进计划进行分析。我们纳入了年龄<18 岁的上肢（UE）和下肢（LE）骨折患者。排除烧伤和昆虫咬伤/蜇伤。进行多变量回归分析以确定 ACS 的预测因素。
61537 例 LE 骨折患者中，0.5%发生 ACS；76216 例 UE 骨折患者中，0.16%发生 ACS。多变量回归分析确定年龄增加、男性、摩托车碰撞和行人撞击伤机制、粉碎性和开放性骨折、胫骨和同时胫骨和腓骨骨折、前臂骨折以及手术固定为 ACS 的预测因素（P 值<0.05）。在 LE 骨折中，34%接受了切开复位内固定（手术时间为 14[8-20]小时），2.1%接受了 ExFix（手术时间为 9[4-17]小时）。在 UE 骨折中，54%接受了切开复位内固定（手术时间为 11[6-16]小时），1.9%接受了 ExFix（手术时间为 9[4-14]小时）。UE 和 LE 骨折手术固定每延迟 1 小时，ACS 的调整后比值比增加 0.4%（P 值<0.05）。
我们的结果可能有助于临床医生识别“易患”ACS 的儿童。需要进一步研究以探讨长骨骨折手术固定的最佳时机，以最大限度地降低儿科 ACS 的风险。
