OKOJ, Volume 13, No. 4

Diagnosis and Treatment of Acute Compartment Syndrome in Children

Sustained increased pressure within the fascial compartments of a limb may result in an acute compartment syndrome. The typical clinical setting of such a syndrome involves a traumatic injury to an extremity. Although increased compartment pressures are most often seen after a fracture, their other typical etiologies include significant soft-tissue trauma, sepsis, animal bites, vascular reconstruction, and elective orthopaedic procedures. This article provides a review of the pathophysiology, epidemiology, diagnosis, and treatment strategies for acute compartment syndrome in children. The timely diagnosis and treatment of this condition affords the greatest likelihood of an optimal outcome, without long-term sequelae or functional limitations.

    • Keywords:
    • pediatric

    • compartment syndrome

    • trauma

    • fasciotomy

    • fracture

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Pitfalls in the Treatment of Femur Fractures in Children and Adolescents

Pediatric fractures of the femoral shaft are common and typically heal well, with excellent outcomes. Despite this, patients with such fractures may experience complications compromising a satisfactory final outcome. This article provides guidance for avoiding the pitfalls leading to these complications. It discusses perioperative complications of pediatric fractures of the femoral shaft, including errors in their diagnosis and concerns in their medical management. It also provides pointers for the common methods of treating such fractures, including casting, external fixation, plate fixation, and flexible and rigid intramedullary nailing. Lastly, it discusses longer-term complications of these fractures, including malunion and leg-length discrepancy.

    • Keywords:
    • pediatric femoral shaft fracture

    • surgical treatment

    • casting

    • external fixation

    • plate fixation

    • intramedullary nailing

    • complications

    • Subspecialty:
    • Trauma

    • Pediatric Orthopaedics

Bony Increased-Offset Reverse Shoulder Arthroplasty

Reverse shoulder arthroplasty has proven useful in numerous pathologic conditions, such as that of pseudoparalytic shoulder with severe rotator cuff deficiency with or without collapse (so-called cuff-tear arthropathy), rheumatoid arthritis, dislocations and sequelae of proximal humerus fractures, and revision shoulder arthroplasty. Despite the advances beyond the constrained reverse prostheses of the 1970s resulting from Grammont’s principles, problems remain with current systems, with high rates of scapular notching and prosthetic instability. Lateralization of the center of rotation of the shoulder joint has been viewed as a potential solution to these persistent problems, and is included in the procedure known as bony increased-offset reverse shoulder arthroplasty. This article presents our surgical technique for this procedure and promising early results of its use.

    • Keywords:
    • reverse shoulder arthroplasty

    • lateralization

    • bone grafting

    • Subspecialty:
    • Shoulder and Elbow