Orthopaedic involvement in viper bite in children in Greece. Report of four cases

Abstract

Background: Venomous snake bites can cause symptoms like pain, swelling, and potential systemic and limb-threatening complications such as compartment syndrome. The paper discusses the role of orthopedic surgeons in managing severe cases where patients develop compartment syndrome.
Case Presentation: Four children aged 10 months to 11 years were treated for venomous snake bites at a public hospital. All bites were on their upper limbs, with the children bitten in various home environments. Symptoms included pain, swelling, ecchymosis, and drowsiness without hemodynamic instability. Antivenom was administered, and two children required emergency fasciotomies due to developing compartment syndrome.
Fasciotomies were performed on two patients, involving multiple incisions to release pressure in the hand and forearm compartments. In one patient, the incision extended to the humerus due to swelling.
The two children who underwent fasciotomy experienced immediate relief, with reduced pain, swelling, and paresthesia. One child developed hydrothorax, which was managed with a drain. For patients without compartment syndrome, neurovascular assessments showed improvement after antivenom treatment. The patients remained in the PICU for 2- 7 days and, when stable, were transferred to the pediatric department. No major complications were noted except for the hydrothorax.
Conclusion: The diagnosis of snake envenomation is based on history, clinical symptoms, and laboratory tests. Treatment includes close monitoring and supportive care with antivenom serum administration. Compartment syndrome is a potential complication, and high vigilance is warranted. Early detection and management are crucial for successful recovery.
Viper bites in children require prompt and thorough management. The involvement of an orthopedic surgeon is key to preventing severe outcomes and preserving limb function.