Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 5926-5934
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5926
Scoring system for poor limb perfusion after limb fracture in children
Ting Zhu, Yu Shi, Qun Yu, Yan-Jun Zhao, Wen Dai, Yan Chen, Shun-Sheng Zhang
Ting Zhu, Yu Shi, Qun Yu, Wen Dai, Yan Chen, Shun-Sheng Zhang, Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Yan-Jun Zhao, Zunran Hospital, Shanghai 200366, China
Author contributions: Zhu T conceived and coordinated the study, designed, performed, and analyzed the experiments, and wrote the paper; Zhao YJ and Yu Q provided professional suggestions about the research design; Shi Y, Dai W, Chen Y, and Zhang SS carried out the data collection and analysis and revised the paper; All authors reviewed the results and approved the final version of the manuscript.
Supported by The Hospital-Funded Clinical Research of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 17CSY01.
Institutional review board statement: The study protocol was approved by the ethics committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine.
Informed consent statement: The need for individual consent was waived by the committee.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Jun Zhao, MHA, Zunran Hospital, No. 123 Zhanghong Road, Minhang District, Shanghai 200366, China. nice_moon@126.com
Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: September 13, 2020
Revised: September 24, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 6, 2020
Abstract
BACKGROUND

Assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome, which is an emergency condition.

AIM

To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.

METHODS

This retrospective study included pediatric patients with a limb fracture and postoperative plaster fixation who were admitted at The Department of Pediatric Orthopedics of Xinhua Hospital between February 2017 and August 2017. The outcome was poor limb perfusion, which is defined as the postoperative use of mannitol. The children were divided into two groups: The normal perfusion group and the poor perfusion group. Key risk factors have been selected by univariable analyses to establish the Grading Scale for Vascular Status.

RESULTS

A total of 161 patients were included in the study: 85 in the normal perfusion group and 76 in the poor perfusion group. There were no significant differences in age, sex, body mass index, ethnicity, cause of fracture, fixation, or site of fracture between the two groups. After surgery, the skin temperature (P = 0.048) and skin color (P < 0.001) of the affected limb were significantly different between the two groups. The relative risk and 95% confidence interval for skin temperature of the affected limb, skin color, and range of motion of the affected limb are 2.18 (1.84-2.59), 2.89 (2.28-3.66), and 2.16 (1.83-2.56), respectively. The grading scale was established based on those three factors (score range: 0-3 points). Forty-one patients (32.5%) with score 0 had poor limb perfusion; all patients with scores 1 (n = 32) and 2 (n = 3) had poor limb perfusion (both 100%).

CONCLUSION

In children undergoing surgery for limb fracture, a higher Grading Scale for Vascular Status score is associated with a higher occurrence of poor limb perfusion. A prospective study is required for validation.

Keywords: Children, Fractures, Compartment syndromes, Evaluation, Open fracture reduction, Retrospective study

Core Tip: The assessment of the vascular status following limb fracture in children is important to evaluate the risk of compartment syndrome, which is an emergency condition. This study aims to establish a simple and efficient grading scale system of limb perfusion in children undergoing surgery for limb fracture, the Grading Scale for Vascular Status (GSVS). The results strongly suggest that in children undergoing surgery following limb fracture, a higher GSVS score is associated with a higher occurrence of poor limb perfusion. A prospective study is required for validation, but GSVS could help prevent compartment syndrome in children after limb fracture.