Long-term recovery after fasciotomy for earthquake-related acute compartment syndrome: a comparative study of pediatric and adult patients

Age-related differences after fasciotomy for earthquake-related acute compartment syndrome (ACS) remain incompletely defined. This study compared pediatric and adult patients with respect to definitive wound closure, baseline injury characteristics, wound-course complexity, and 12-month recovery. This retrospective comparative cohort included 29 patients who underwent fasciotomy for earthquake-related ACS (9 pediatric, 20 adult). Baseline variables included time under rubble, time to hospital admission, number of fasciotomy incisions, affected extremity distribution, associated fracture, associated vascular injury, Injury Severity Score (ISS), and vacuum-assisted closure (VAC) duration. Wound-course variables included delayed primary closure (DPC), split-thickness skin grafting (SG), re-debridement count, wound infection, graft failure, and revision surgery. Long-term recovery was assessed at 6 and 12 months using full muscle strength, full joint range of motion (ROM), and joint stiffness. Unfavorable 12-month recovery was defined as failure to regain full ROM and/or full muscle strength, or persistence of clinically relevant stiffness. Time under rubble was comparable between pediatric and adult patients (16.7 ± 11.3 vs. 14.8 ± 7.8 h, p = 0.92), whereas time to hospital admission was longer in pediatric patients (65.5 ± 29.5 vs. 40.1 ± 15.6 h, p = 0.01). DPC was achieved in 88.9% versus 10.0% (p < 0.001), while SG was required in 11.1% versus 90.0% (p < 0.001). VAC duration was shorter in pediatric patients (12.4 ± 2.3 vs. 22.6 ± 8.2 days, p < 0.001), and re-debridement count was lower (0.7 ± 0.5 vs. 2.1 ± 1.0, p = 0.002). At 6 months, full muscle strength (88.9% vs. 45.0%, p = 0.043) and full ROM (77.8% vs. 35.0%, p = 0.050) favored the pediatric group. At 12 months, full ROM remained numerically higher in pediatric patients (77.8% vs. 50.0%, p = 0.23), while unfavorable 12-month recovery occurred in 11.1% versus 50.0% (p = 0.096). In exploratory multivariable analysis, SG, re-debridement count, and 6-month stiffness were associated with unfavorable recovery, whereas pediatric age group was protective. Associated fracture and ISS were not independently associated with unfavorable 12-month recovery. Pediatric patients showed more favorable definitive closure profiles and less complex wound courses despite later presentation. They also showed signals of more favorable longer-term recovery, although between-group differences in 12-month functional outcomes did not reach conventional statistical significance. Wound-course factors and, to a lesser extent, baseline injury burden may partly explain age-related differences in recovery after fasciotomy for earthquake-related ACS.