Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5926
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
Children are encouraged to practice physical activities to promote their health and normal development. Fractures in children are common, with an incidence of about 137-201 per 10000 person-years. Poor limb perfusion is a possible and severe complication following pediatric limb fracture. If not identified and not managed promptly, patients may experience hypoperfusion or venous return obstruction and present with a series of physiological or pathological changes such as pain, swelling, and pale skin. In severe cases, it may lead to compartment syndrome, acute avascular necrosis of the nerves or muscles, and even deformity and disability.
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.
To establish a simple and efficient grading scale of limb perfusion in children undergoing surgery for limb fracture.
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 is poor limb perfusion, which is defined as the postoperative use of mannitol. The children were divided into the normal perfusion group and the poor perfusion group. The key risk factors were selected by univariable analyses to establish the Grading Scale for Vascular Status (GCVS).
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 of the affected limb (P = 0.048) and skin color (P < 0.001) 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 were 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%).
In children undergoing surgery for limb fracture, a higher GCVS score is associated with a higher occurrence of poor limb perfusion. A prospective study is required for validation.
The patients are from a single center, and the resulting sample size is small. The outcome is based on mannitol administration, not on a formal diagnosis. No validation of the scoring system was done. These issues will have to be addressed in future studies.