title: Volkmann contracture and compartment syndromes after femur fractures in children treated with 90/90 spica casts.
abstract: Nine pediatric patients (mean age 3.5 yrs) with low energy femur fractures were treated with 90/90 spica casts and developed leg compartment syndromes, Volkmann contracture, and ankle skin loss. These cases are detailed and a proposed mechanism leading to this devastating complication is explained. The authors believe the technique of an initial below knee cast, and then using that cast for applying traction while immobilizing the child in the 90/90 spica is potentially dangerous. Alternative spica application methods are advocated.
authors.affiliation: Department of Orthopaedics, Children's Hospital and Health Center, San Diego, California, USA. pedsortho@chsd.org
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Mubarak
authors.forename: Steve
authors.initials: S
authors.lastname: Frick
authors.forename: Ernest
authors.initials: E
authors.lastname: Sink
authors.forename: Karl
authors.initials: K
authors.lastname: Rathjen
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Noonan
mesh_terms: D002370:Casts, Surgical / Q000009:adverse effects*; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000209:etiology*; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D003668:Pressure Ulcer / Q000209:etiology; D014143:Traction