Compartment Syndrome in Operatively Managed Pediatric Monteggia Fractures and Equivalents

John Kopriva, John Awowale, Paul Whiting, Andrew Livermore, Alex Siy, Scott Hetzel, Kenneth Noonan
Journal of Pediatric Orthopedics 2020, 40 (8): 387-395

BACKGROUND: Acute compartment syndrome (ACS) is not commonly associated with pediatric Monteggia fractures or Monteggia equivalents (MF/ME). The aims of this study were: (1) To document a rate of ACS among children with operatively managed MF/ME, comparing this to the rate of ACS in classically associated Type 3 supracondylar humerus (T3-SCH) fractures at the same institution; (2) To determine which patients with MF/ME are at highest risk for ACS.

METHODS: Children ages 2 to 12 with MF/ME requiring operative management at an academic institution over a 14-year period were identified. The Monteggia fractures were characterized using the Bado classification; equivalent injuries were identified according to established criteria. Similarly, all patients with T3-SCH fractures managed over the same period were identified. Record review included demographic, procedural, and radiographic variables. Statistical analysis compared the rates of ACS in both groups and determined risk factors associated with developing ACS in patients with MF/ME.

RESULTS: The rate of ACS in MF/ME was 9 of the 59 (15.3%), which was significantly higher than the rate of ACS in T3-SCH fractures 2 of the 230 (0.9%) (P=0.001). Comparing MF/ME with ACS to those without; there was no difference in sex (P=1.00), Bado Type (P=0.683), or Monteggia fracture versus equivalent (P=0.704). MF/ME with preoperative vascular deficits (22.2%) and those undergoing intramedullary fixation of the radius were more likely to develop ACS (P=0.021 and 0.015, respectively), and there was a trend toward higher rates of ACS among MF/ME with preoperative neurological deficits (P=0.064).

CONCLUSIONS: Patients with operatively managed MF/ME had a significantly higher rate of ACS compared with patients with T3-SCH fractures. With no predisposition based on Bado classification or Monteggia fracture versus equivalent, all operatively managed MF/ME appear to be at risk for ACS. Patients with preoperative neurovascular deficits and those undergoing intramedullary radial fixation develop ACS at higher rates. Careful assessment of the forearm for signs and symptoms of ACS both before and after fixation is critical.

LEVEL OF EVIDENCE: Level III-retrospective case control.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.