Analysis of compartment syndromes in lower extremity pediatric and adolescent trauma - are there predictors of a late onset?

•CS occurred most commonly at the lower leg (45 (67.2 %)), followed by the foot (16 (23.9 %)) and thigh (6 (9.0 %)).•Dislocated fractures and fractures of the foot always led to an early onset of the compartment syndrome.•Tibial shaft fracture and surgical treatment with intramedullary nailing showed a significant frequency of late onset compartment syndromes.•Ten (17.9 %) patients showed a CS on several locations (2–3 locations) at the same time.•A peripheral nerve lesions (11, 16.4 %) presented to be the most common complication. Purpose of the study was to answer the question, if there are common fracture or injury characteristics, which help to identify patient at risk for a secondary compartment syndrome. Between 2003 and 2022 all children and adolescents who were treated for a traumatic compartment syndrome in a lower extremity were retrospectively evaluated. Patient's demographics were recorded, the underlying trauma mechanism identified. Fractures were classified, treatment and complications were analyzed. We differentiated two groups of patients (early onset vs. late onset) and compared trauma mechanism, fracture location, classification and treatment between those two entities. Our collective consisted of 56 children and adolescents with 67 compartment syndromes, with an average age of 14.1 years (5–17). 41 (73.2 %) of the patients were male and 15 (26.8 %) female. Most people in our sample had previously been involved in traffic accidents (64.3 %), with the most common mechanism of injury being "motorbike accident" (34.3 %) and "pedestrian/cyclist accident against car" (26.9 %). There was an accumulation of fractures of the lower leg, in particular tibial shaft fractures (AO 42 and 43A; 49.3 %). In our survey, dislocated fractures and fractures of the foot always led to an early onset of compartment syndrome. The tibial shaft fracture and the surgical treatment with intramedullary nailing showed a significant frequency in the late onset group. Special attention should be paid to pediatric and adolescent patients with tibial shaft fracture and surgical treatment with intramedullary nailing in order to detect and treat a possible late onset of a compartment syndrome at an early stage.