Dr. Ebraheim’s educational animated video describes the Compartment Syndrome in Children.

my new book about compartment syndrome
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Compartment syndrome in children can go unrecognized. It is really hard to examine children. Children have a poor perception of numbness and paresthesia and they always cry from injury or from fear. The actual amount of pain that the child feels can not be estimated. It is also difficult to remove the splint or the dressing and examine the child.
In adults, well-established compartment syndrome is historically defined by the 5 P’s: these 5 P’s occur in established compartment syndrome and when these findings are present, it is usually too late.
•Pain/swelling
•Pulselessness
•Paresthesia
•Pallor
•Paralysis
These findings are considered late presentation (irreversible damage). If the pressure is not released within 6-8 hours from its onset, there is irreversible damage to the muscles.
Note for the diagnosis of impending CS: it is better to diagnose compartment syndrome when it is impeding rather than when it is established. The majority of clinicians will depend on a high index of suspicion supplemented by the clinical diagnosis and pressure measurements.
Usually the clinician’s findings of impending CS are:
•Pain more than surgery or injury
•Tense swelling
•Pain with passive stretch
If compartment syndrome is suspected, measure the compartment pressure if you can. 30+ mmHg or within 30 mmHg of the diastolic pressure. If the compartment pressure is greater than 30 mmHg (Absolute measurement) or within 30 mmHg of the diastolic pressure, then immediate fasciotomy should be done. The clinical findings are different in children and physicians are usually not familiar with the clinical findings in children.
Clinical findings in children include:
•Increased pain with increased pain medication requirements.
•Increased agitation
•Increased anxiety of the child, parents and nurses.
When the doctor goes on the floor and finds the nurses are with the parents in the room of the child and the child is in pain and everybody else is quite, then there is a problem. The doctor should start by removing the dressing and checking the extremity. Bivalving the cast will decrease the pressure significantly. When in doubt measure the pressure. Objective findings such as measuring the pressure may be necessary to exclude the presence of compartment syndrome in children. The doctor may rely on his clinical judgment alone to diagnose compartment syndrome and do fasciotomy, however the doctor should not rely on this clinical judgement alone to exclude compartment syndrome especially if the patient has clinical findings of compartment syndrome.
Areas of concern for development of CS:
•High energy fractures
•Multiple fractures in the same extremity such as floating elbow
•Multiple closed reduction in a child.
•The use of a fibroblast cast: it can be two times tighter than plaster
It is important to fix the fracture and provide post operative monitoring with possible delay in feeding the patient. a delay in the diagnosis of these patients may lead to bad outcome. In children, compartment syndrome can occur in the upper extremity and lower extremity as with these two cases. The use of Acell that helps with skin graft regeneration can be used in an outpatient basis to cover the defect. The use of a VAC is always helpful.

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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step

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