News : Toddler bed

The report recounts an unusual case of syndrome of the leg and foot resulting from hanging on the side of a toddler bed in a 11/2-year-old boy. Parents apparently found the patient on the side of the bed in the morning. Presentation at the hospital revealed obvious tense compartments of the leg and foot. Intraoperative pressure> 100 mm Hg. MUSCLE complete with secondary closure and skin grafts were performed. An ankle-foot orthrosis was used to prevent the spread of equine ankle. Jobst pressure garments have been used to prevent hypertrophic scars. From a year monitoring the march showed normal function, and joint range of motion. Social services have been consulted and the U.S. Consumer Product Safety Commission has been notified. As pediatric doctors, we must be aware of possible dangers and potential in the child's environment. This case represents a unique syndrome linked to the continuing rise of the member and compression.
Numerous studies and case reports have shown that persistent elevation of the member or can cause compression compartment syndrome.2, 5 Gallows Bryant baby or traction, where the leg is persistently high, carries a high risk of syndrome children 1 year or> 30 lbs Tourniquet use can cause compartment syndrome.4, 15, we present a case that illustrates an unusual combination of the night arm elevation and compression presenting as compartment syndrome.
A 11/2-year-old boy presented to our emergency department with his parents to unilateral leg pain and swelling. It is history given by parents is that they have found their child the morning of his bed with one leg caught between the sidebars of his toddler bed. They were last seen when he was in bed about 10 hours earlier. His bedroom door was closed and they have not heard crying all night. Their bedroom is located quite a distance from their son in the room. The discovery of the patient that morning, the mother reports, the patient was sucking its thumb, as usual (Avid "inch-Sucker"), but not crying. The disengagement of the leg, the patient whimpered. Although the child was upset at the hospital, the surgeon of the initial consultation indicated that the patient seems to have little pain but was holding his left leg very calm.

On closer examination in the emergency room, lower leg and foot swelling was spectacular with all the compartments is very tense. The diagnosis obvious syndrome was made. The child was taken emergently to the operating room after a coagulopathy and appropriate work history and physical examination revealed no indications against. Intraoperative compartment pressures measured> 100 mm Hg in the lower leg and foot. MUSCLE performed.10 were full, 11
Other findings included significant initial creatine kinase value of 16 779 IU / L (normal 61-224). Hydration, alkalinization urine, and urine output were used to prevent kidney damage associated myoglobin. Levels of creatine kinase and myoglobin urine screens were followed up postoperative normalization. Secondary and closing half-thickness skin graft was completed the 5th postoperative day.
Social services was consulted. No evidence of abuse was identified. The U.S. Consumer Product Safety Commission has been notified. No reply has been received well as personal telephone contact revealed that other complaints were received regarding the toddler beds, including head injuries related to a child being stuck between sidebars. It was also reminiscent of certain types of toddler beds.
As the child has shown a tendency to post-equine ankle, ankle-foot orthosis was used to prevent this problem would be even seen in one of Volkmann contracture of the forearm. Jobst pressure garment was used to reduce hypertrophic scars. On the one year follow-up revealed a loss of calf circumference 1/2-cm model approach normal, and normal range of motion without obvious change. Light skin graft hypertrophy was observed. The child was encouraged to continue monitoring to look for residual problems, including weakness, sensory disturbance, or leg length discrepancy.

Although the pathophysiology of complex details compartment syndrome, its definition is simply stated as a condition in which increased pressure tissue within a limited space compromises the circulation and function of the content of this space, namely involved muscles and nerves. Anything that increases the compartment content or decrease the size of the compartment can precipitate the syndrome.
Syndrome in a normal leg was demonstrated when, in the hemi-lithotomy position during surgery procedure.5 The two members of elevation and compression were implicated.2, 4.15 lower the leg compartment pressures were presented to increase with passive ankle dorsiflexion.6 prolonged tourniquet use during surgical procedures have been associated with compartment syndrome.
Prevention of this event and similar cases is paramount. Although the guidelines have been drafted and implemented to the crib safety, 1.13 very little has been written about toddler beds. It is obvious that the side rails should be close together not to allow any part of the body of a toddler being caught between the rails. In nurseries, it is recommended that the spaces between the rails should be 2 3 / 8 inches or less.1 study falls out of bed, it was shown that falls from beds and cribs typically not serious, multiple, visceral or life-threatening injuries.8, 12 This suggests that falls from height are not serious in most cases. A May suggest lowering the height of the mattress of a toddler bed to better prevent injuries caused by falls.