Scientific Article   |    
Rattlesnake Bites in Children:Antivenin Treatment and Surgical Indications
Brian A. Shaw, MD; Harish S. Hosalkar, MD
View Disclosures and Other Information
Investigation performed at Valley Children's Hospital, Madera, California

Brian A. Shaw, MD
Harish S. Hosalkar, MD
Department of Orthopaedic Surgery, Valley Children's Hospital, 9300 Children's Way, Madera, CA 93611. E-mail address for B.A. Shaw: bshaw@childrenscentralcal.org

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2002 Sep 01;84(9):1624-1629
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


Background: Orthopaedic surgeons working in the Americas may be consulted in the care of patients bitten by venomous rattlesnakes (genus Crotalus ), particularly with regard to the possibilities of compartment syndrome and soft-tissue destruction. Despite considerable evidence regarding the safety and efficacy of antivenin in the treatment of rattlesnake bites in adults, controversy persists regarding the roles of antivenin and surgery in the treatment of rattlesnake envenomations in children. Our hypothesis is that aggressive use of antivenin is just as effective and safe for children as it is for adults.

Methods: We retrospectively reviewed the charts of twenty-four consecutive patients who had been managed at our hospital because of a bite from a western diamondback rattlesnake. Nineteen of the twenty-four patients had been envenomated. The uniformity of collected data was facilitated by the use of an intensive-care-unit protocol during the ten-year period that was reviewed. A questionnaire was developed for long-term follow-up.

Results: Aggressive use of polyvalent equine antivenin safely prevented the need for surgery in sixteen of the nineteen envenomated patients. Of the three patients who had surgical treatment, two were managed with limited soft-tissue d�bridement and one was managed with a fasciotomy of the leg because of a compartment syndrome that occurred when adequate antivenin was withheld. No serious adverse effects were noted in association with the antivenin, and no functional impairments were noted at the time of discharge.

Conclusion: Antivenin, rather than surgery, is the proper initial treatment of severe rattlesnake envenomations in children.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Rattlesnake bite with associated compartment syndrome: what is the best treatment? J Bone Joint Surg Am 2003;85-A(6):1163-4; author reply 1164.
    Management of venomous snakebite injury to the extremities. J Am Acad Orthop Surg 2010;18(12):749-59.
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    New York - Icahn School of Medicine at Mount Sinai
    W. Virginia - Charleston Area Medical Center
    District of Columbia (DC) - Children's National Medical Center
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina