Compartment syndrome (CS), a serious complication in paediatric trauma, can be prevented by timely diagnosis and adequate therapy. From 1990 to 2000 we treated 22 patients with suspected CS in the arm. Incision into the intrafascial spaces of nine forearms and three hands confirmed the diagnosis. In 10 patients, fracture had caused the syndrome, and in two, the cause was contusion. In two patients the CS resulted from incorrect treatment procedures. We also treated 22 patients with suspected CS in the lower limb. The diagnosis was confirmed in 15. Incision into the intrafascial spaces was performed during treatment, 13 times on the crus and twice on the femur. Fractures were always the primary cause. In the upper limb outcomes were good. One patient developed a Volkman’s contracture but this was only disfiguring. Some patients treated for lower limb CS had cosmetic after-effects, but only one patient, in whom CS was diagnosed late, had functional after-effects. We advocate permanent monitoring of intrafascial pressures, using piezoelectric sensors, and timely performance of adequate dermofasciotomies.
We evaluated the outcomes of fractures of the femoral shaft treated by elastic stable intramedullary nailing (ESIN). From 1994 to 1999, 100 children were treated. The mean age of the 65 boys and 35 girls was 8.7 years. The mean follow-up was 5.4 years. There were 30 type-AII fractures, 21 type-AIII, 17 type-AI, 13 type-BI, nine type-BII, four type-BIII and six type-CI. Implants were inserted using the ascending method in 92 patients and the descending method in eight. The mean period of implant insertion was 172 days. Steel implants (Medin) were used in 54 patients and titanium implants (Synthes) in 46. Evaluated according to Flynn, 86 patients had an excellent outcome, 13 a satisfactory outcome and one a poor outcome. The greatest limb length discrepancy was 3.2 cm. A steel implant was used in eight of the 13 patients whose results were merely satisfactory and in the patient who had a poor outcome. There were no pyogenic complications. In five patients, the inserted implant required shortening during treatment. We believe that in 5 to 12-year-old patients the ESIN method with titanium implants can be used to treat femoral shaft fractures.
