title: Acute compartment syndrome of the upper extremity in children: diagnosis, management, and outcomes.
abstract: OBJECTIVE
  Acute compartment syndrome (ACS) of the upper extremity is a rare but serious condition. The purpose of this study was to determine the etiology, diagnosis, treatment, and outcome of ACS of the upper extremity in a pediatric population.
  
  
  METHODS
  We performed a retrospective chart review of all patients who underwent a decompressive fasciotomy for ACS of the upper extremity. Data collected included demographics, injury details, presenting symptoms, compartment measurements, time to diagnosis, time to treatment, and outcomes at the latest follow-up.
  
  
  RESULTS
  Twenty-three children underwent fasciotomies for ACS of the forearm (15) and hand (8), at an average age of 9.3 years (range 0-17.8 years). The most common etiologies were fracture (13) and intravenous (IV) infiltration (3). The most common presenting symptoms were pain (83 %) and swelling (65 %). Compartment pressures were measured in 17/23 patients, and all but two patients had at least one compartment with a pressure >30 mmHg. The final two patients were diagnosed and treated for ACS based on clinical signs and symptoms. The average time from injury to fasciotomy was 32.8 h (3.7-158.0 h). Long-term outcome was excellent for 17 patients (74 %) and fair for 5 (22 %), based on the presence of loss of motor function, stiffness, or decreased sensation. One patient with brachial plexus injury and poor baseline function was excluded from functional outcome scoring. There was no association between the time from diagnosis to fasciotomy and functional outcome at the final follow-up (p = 1.000).
  
  
  CONCLUSIONS
  Although ACS of the upper extremity in children is often associated with a long delay between injury and fasciotomy, most children still achieve excellent outcomes. The majority of patients presented with pain and at least one additional symptom, but treatment was often delayed, implying that ACS of the upper extremity in children is a difficult diagnosis to establish and may be associated with a prolonged clinical time course.
authors.affiliation: Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., 2nd Floor Wood Building, Philadelphia, PA 19104 USA.
authors.forename: Wajdi W
authors.initials: WW
authors.lastname: Kanj
authors.affiliation: Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., 2nd Floor Wood Building, Philadelphia, PA 19104 USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Gunderson
authors.affiliation: Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., 2nd Floor Wood Building, Philadelphia, PA 19104 USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Carrigan
authors.affiliation: Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., 2nd Floor Wood Building, Philadelphia, PA 19104 USA.
authors.forename: Wudbhav N
authors.initials: WN
authors.lastname: Sankar
keywords: Acute compartment syndrome; Children; Fasciotomy; Upper extremity