The impact of acute compartment syndrome on the outcome of tibia plateau fracture (original) (raw)
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BMC musculoskeletal disorders, 2017
The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the developm...
Journal of Orthopaedic Trauma, 2019
Objective: To test previously established radiographic predictors of compartment syndrome in tibial plateau fractures and determine if novel measurements may further improve a surgeons ability to identity patients at high risk for developing this outcome. Design: Retrospective review. Setting: Academic level I trauma center. Patients: 513 patients with tibial plateau fractures treated operatively over a 10-year period (OTA/AO 41B1-3 & 41C1-3; Schatzker I-VI). Intervention: Previously established plain film radiographic measurements and novel computed tomography (CT) soft tissue measurements. Main Outcome Measure: Acute compartment syndrome (ACS).
BMC Musculoskeletal Disorders, 2020
Background: The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome. Methods: 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high-vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and overriding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p < 0.05. Results: Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm. Conclusions: One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.
Indian Journal of Orthopaedics, 2015
Background: Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good. Materials and Methods: Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system. Results: At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed. Conclusions: Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate.
Acute compartment syndrome (ACS) is a terrible complication that can occur in tibial fractures, especially following high energy trauma, and if it is misdiagnosed it could bring to severe consequences. In this report we present a case of a 19-year-old caucasian male rugby player with a medial tibial plateau fracture atypically occurred after a low energy non-contact injury during sports. The diagnosis is generally clinic, based on physical examination, characterized by classic symptoms like severe pain, pallor or pulselessness and on accurated patient history taking. Unfortunately, in rare cases, clinical details are not enough and even further investigations can not predict wether the chosen surgical treatment will be completely decisive or another procedure will be necessary.
The Prognosis of Management Following Tibial Plateau Fractures
Journal of Orthopaedic Science and Research, 2024
Background: Tibial Plateau Fractures (TPF) consist for one percent of all treated fractures. Open Reduction Internal Fixation (ORIF) and reconstruction of articular surfaces are the mainstay of management. In this study, we sought to assess the risk of identifying cases with high risks for poor postoperative outcomes. Methods: A total of 123 tibial plateau fractures treated at the Basrah Teaching Hospital were prospectively enrolled. The demographics, injury data, surgical management and SMFA scores were obtained. Variables included sex, age, BMI, comorbidity, open fracture, high-energy injury mechanisms, vascular or nerve injuries, residual TP depression, tibial spine fracture and OTA fracture types. Results: Morbidity was recorded in 55(44.7%) patients. Seventy-one patients smoked during the study period. The high-energy mechanism of trauma was documented in 55.3% of cases, whereas low-energy was found in 44.7% of cases. Compartment syndrome was reported in 34.1% of cases. Open fractures were observed in 32.5% of the cases. The tibial spine was involved in 29.3% of cases. OTA class (C) was more frequently reported than class (B) (63.4% vs. 36.6%). Residual tibial plateau depression was reported in 43.1% of cases. The preoperative fracture depression range value was 1-39 mm while the postoperative fracture depression range was 0-5.5 mm. Conclusion: SMFA score was used to assess the risk of postoperative dysfunction. Older age, obesity, severe comorbidity, tobacco smoking, alcohol consumption, high trauma energy, large postoperative depression, tibial spine involvement, female sex, complicated open fracture, type C fracture and high SMFA score are predictive risk factors for poor outcomes.
International Orthopaedics, 2005
We studied 39 patients with 42 diaphyseal tibial fractures in whom we suspected a high risk for the development of a compartment syndrome. We measured the anterior absolute compartment pressure (ACP) every 12 h for 72 h and also recorded the differential pressure (ΔP=diastolic blood pressure−ACP). Fasciotomy of the extremity was only performed when the differential pressure was less than 30 mmHg for more than 30 min. The highest values of the ACP were recorded between 24 h and 36 h after admission. Three fractures had a differential pressure less than 30 mmHg and all were treated by fasciotomy. In three fractures the ACP was equal to or higher than 50 mmHg, of which two had a differential pressure less than 30 mmHg. The patients were followed up for a mean of 36 months (29-45). All fractures healed, and none of our patients showed any sequelae of compartment syndrome at their last review. Résumé Nous avons étudié 39 malades avec 42 fractures tibiales diaphysaires que nous avons suspecté d'un syndrome compartimental. Nous avons mesuré la pression du compartiment antérieure (ACP) chaque 12 h pendant 72 h et avons aussi enregistré la pression différentielle (ΔP=tension diastolique−ACP). Une fasciotomie de la jambe a été exécutée seulement quand la pression différentielle était inférieure à 30 mmHg pendant plus de 30 min. Les plus hautes valeurs de l'ACP ont été enregistrées entre 24 et 36 h après l'admission. Trois fractures avaient une pression différentielle de moins de 30 mmHg et toutes ont été traitées par fasciotomie. Dans trois fractures l'ACP était égale ou supérieure à 50 mmHg , avec, pour deux, une pression différentielle de moins de 30 mmHg. Les malades ont été suivis pendant une moyenne de 36 mois (29-45). Toutes les fractures ont guéri et aucun de nos malades n'a montré de séquelle d'un syndrome de compartiment à la dernière révision.
Medial Tibial Plateau Fractures: a New Classification System
Journal of Trauma: Injury, Infection & Critical Care, 2007
Background: Fractures of the medial plateau are associated with significant soft tissue injuries. A predictive measure of which medial plateau fractures are at higher risk of associated injuries has not been described. The authors propose a simple classification that is both easy to remember, recognize, and predictive of associated injuries. A type A fracture is where the fracture line is medial to the intercondylar spines, a type B is where the fracture line is within the intercondylar spines, and a type C fracture is where the fracture line is lateral to the intercondylar spines. Methods: All patients treated at a Level I trauma center for tibial plateau fractures between 1998 and 2005 were identified. The radiographs of these patients were reviewed, and 28 patients were included in the study. The medical charts were then reviewed, and any associated injuries were noted. The patients were placed into one of three groups based on their fracture pattern. Results: Of the seven type A fractures, there was one patient with compartment syndrome (14%) and another with an ACL tear and medial meniscal tear. Of the 12 type B fractures, there were four patients with compartment syndrome (33%) and one with an ACL avulsion and medial meniscal tear. Of the nine type C fractures, there were six patients with compartment syndrome (67%), one of these also had a peroneal nerve injury, and another patient had an anterior tibial artery injury that required vascular surgery intervention. Conclusion: As the fracture line moves laterally the severity of the associated injuries increases. We think it is significant that the only neurologic and vascular injuries seen were in the type C fractures. Also, we noted an increase propensity for type C fractures to develop compartment syndrome. This information can be helpful during the initial evaluation of the patient so that the physician can be wary of these developing problems.