Compartment syndrome in children with a supracondylar fracture: not everyone has risk factors

Objectives: To clarify the incidence, associated conditions, and timing of fasciotomy for compartment syndrome (CS) in children with a supracondylar (SC) fracture of the humerus. Design: A retrospective trauma system database study. Setting: Accredited trauma centers in Pennsylvania. Patients: A statewide trauma database was searched for children 2-13 years of age admitted with a SC fracture between January 2001 and December 2015. Four thousand three hundred eight children met inclusion criteria. Intervention: Treatment of a SC fracture. Main Outcome Measurement: Diagnosis of CS/performance of a fasciotomy. Results: During the study period, 21 (0.49%) children admitted with a SC fracture of the humerus were treated with fasciotomy. CS/ fasciotomy was more likely in males (P = 0.031), those with a nerve injury (P = 0.049), and/or ipsilateral forearm fracture (P <0.001). Vascular procedure, performed in 18 (0.42%) children, was strongly associated with CS/fasciotomy (P <0.001). Closed reduction and fixation of a forearm fracture was associated with CS (P = 0.007). Timing of SC fracture treatment did not influence outcome. Fasciotomy was performed subsequent to reduction in 13 subjects; mean interval between procedures was 23.4 hours (r = 4.5-51.3). Conclusions: Risk factors for CS exist; however, they are not required for the condition to develop. CS may develop subsequent to admission and/or SC fracture treatment. In timing of operative management and hospitalization, the results support contemporary practice.