What is the effect of compartment syndrome and fasciotomies on fracture healing in tibial fractures? (original) (raw)
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Journal of Orthopaedics and Traumatology, 2014
Background We sought to examine the occurrence of acute compartment syndrome (ACS) in the cohort of patients with tibial diaphyseal fractures and to detect associated risk factors that could predict this occurrence. Materials and methods A total of 1,125 patients with tibial diaphyseal fractures that were treated in our centre were included into this retrospective cohort study. All patients were treated with surgical fixation. Among them some were complicated by ACS of the leg. Age, gender, year and mechanism of injury, injury severity score (ISS), fracture characteristics and classifications and the type of fixation, as well as ACS characteristics in affected patients were studied. Results Of the cohort of patients 772 (69 %) were male (mean age 39.60 ± 15.97 years) and the rest were women (mean age 45.08 ± 19.04 years). ACS of the leg occurred in 87 (7.73 %) of all tibial diaphyseal fractures. The mean age of those patients that developed ACS (33.08 ± 12.8) was significantly lower than those who did not develop it (42.01 ± 17.3, P \ 0.001). No significant difference in incidence of ACS was found in open versus closed fractures, between anatomic sites and following IM nailing (P = 0.67). Increasing pain was the most common symptom in 71 % of cases with ACS. Conclusions We found that younger patients are definitely at a significantly higher risk of ACS following acute tibial diaphyseal fractures. Male gender, open fracture and IM nailing were not risk factors for ACS of the leg associated with tibial diaphyseal fractures in adults. Level of evidence Level IV.
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 after Lower Leg Fracture
European Journal of Trauma, 2004
Background: In acute situations, fasciotomy can be done prophylactically or as early therapeutic decompression, the latter being performed as soon as the first symptoms of compartment syndrome are present. Patients and Methods: Results of fasciotomy after lower leg fracture performed between 1992 and 2001 were reviewed with emphasis on the efficacy of treatment and morbidity of the procedure sec. Patients, divided into a prophylactic group (A) and a therapeutic fasciotomy group (B), were interviewed and examined, focusing on late sequelae of compartment syndrome and of the fasciotomy sec. Results: 52 patients were followed up after a median period of 40 months, 18 in group A and 34 in group B. All fractures in group A were operated within 24 h, one third of patients in group B underwent surgery later. In group A, one short foot syndrome was found. In group B, five amputations were performed for ischemic muscle necrosis, two short foot syndromes were observed, and five legs showed other late compelling signs of manifest compartment syndrome. In the 31 legs without sustained compartment syndrome, only seven had no fasciotomy-related abnormalities besides a scar; reduced endurance and swelling were most frequently found. An iatrogenic superficial peroneal nerve lesion was diagnosed in seven legs. Conclusion: Outcome after prophylactic fasciotomy seems to be superior to that after early therapeutic decompression. Though prophylactic fasciotomy is effective, its morbidity is quite high, with long-term consequences in three quarters of patients.
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.
The impact of acute compartment syndrome on the outcome of tibia plateau fracture
European Journal of Orthopaedic Surgery and Traumatology, 2017
Schatzker type V/VI fractures were the most prevalent type of fractures seen among patients. Conclusion The infection rate found is lower than in other recently published studies. The incidence of delayed union or nonunion of the fracture was also lower than in other publications in the literature. Early decompression through double-or single-incision fasciotomy does not increase the risk of infection or nonunion of the fracture. The delayed union rates found in this study are lower than those in previous studies. Level of evidence Level IV prognostic.
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.
Malaysian orthopaedic journal, 2016
Acute Compartment Syndrome is a limb-threatening emergency and it occurs most commonly after fractures. The aim of our study is to find out the effectiveness of serial measurement of differential pressure in closed tibial diaphyseal fractures, in diagnosing acute compartment syndrome, using Whiteside's technique. A total of 52 cases in the age group of 15 to 55 years admitted with closed fractures were studied for serial compartment pressure as well as serial differential pressure. Eight patients had persistent compartment pressure > 40mmHg, out of which only two patients had persistent differential pressure < 30mmHg and these two patients underwent fasciotomy. Thus, by measuring the compartment pressure serially and calculating differential pressure serially, acute compartment syndrome can be diagnosed or ruled out with higher precision, so that unnecessary fasciotomies can be avoided.
Curēus, 2024
Post-traumatic compartment syndrome in the lower extremity has been commonly associated with fractures of the tibia. Only in rare cases, this critical condition might be related to isolated fibular fractures. We present a rare case of delayed onset of acute compartment syndrome after a solitary fracture of the fibula. A 40-year-old man with a history of coagulation disorders due to hepatic cirrhosis was admitted to a neighboring hospital after a car accident with left-sided fractures to ribs 9 and 10 and a transverse fracture in the mid-shaft of the left fibula. He was discharged from the hospital five days later with a posterior long leg splint and anticoagulant therapy. However, three days after discharge, he was seen in the emergency department of our hospital with severe pain and extensive swelling in the left leg. Weak posterior tibial and dorsalis pedis pulse in the right foot were detected. Moreover, sensory disturbances were found in the tibia and foot. Passive hallux dorsiflexion and plantar flexion were causing acute intense pain. A triplex ultrasound was negative for deep vein thrombosis. Apart from the clinical findings, the diagnosis of compartment syndrome was confirmed after evaluating intracompartment pressure measurements. The patient was taken emergently to the operating room for four-compartment fasciotomies. A large intramuscular hematoma was evacuated. Skin closure was accomplished in two stages within two weeks. Six weeks postoperatively, there was no sign of compartment syndrome sequelae and the patient was free of symptoms without any neurovascular deficiency in the operated limb and walked without crutches. Ten weeks later, he returned to his pre-injury daily activities. Although the majority of compartment syndrome cases are reported after high-energy trauma, patients with both coagulation disturbances and anticoagulation treatment are at higher risk of developing compartment syndrome secondary to simple fracture patterns.
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).