Compartment Syndrome in Tibial Plateau Fractures: Do Previously Established Predictors Have External Validity?

Marchand, Lucas S.; Working, Zachary M; Rane, Ajinkya A.; Elliott, Iain S.; Gilbertson, Ellen; Rothberg, David L.; Higgins, Thomas F.; Haller, Justin M.

doi:10.1097/bot.0000000000001703

Cited by 23 publications

(26 citation statements)

References 17 publications

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“…However, there is a relative paucity of literatures looking comprehensively at fracture patterns and ACS nor has there been few approaches to detect any relevant predictors to identify the possibility of ACS. It is generally accepted that higher-grade Schatzker classification and AO/OTA classification play a critical role in the development of ACS and correlate to the subsequent ACS occurrence closely [ 6 , 7 , 16 , 17 ]. A recent retrospective cohort study reporting that the presence of a non-contiguous tibial fracture or knee dislocation was a radiographic predictor of ACS [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of acute compartment syndrome of the lower leg in adults following tibial plateau fractures

Deng

et al. 2021

J Orthop Surg Res

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Background Acute compartment syndrome (ACS) is an underestimated complication following tibial plateau fractures. Understanding predictors of ACS in the lower leg after a fracture of the tibial plateau may guide earlier diagnosis and promptly decompressed by surgical fasciotomy. To date, however, there are few large-scale sample literatures to investigate the predictors of it. The purpose of our study was to evaluate the prevalence rate of ACS associated with tibial plateau fractures and identified any such predictors with the development of ACS. Materials and methods From January 2015 to January 2020, a total of 1119 consecutive patients (1119 fractures) including 703 males and 416 females with an average age of 40.7 years (18 to 80 years) in tibial plateau fractures who presented to a university-affiliated hospital with level-I trauma center were included. The presence of ACS and associated predictors were collected from patients’ electronic medical records. Associated predictors included gender, age, fracture pattern (open or closed), mechanisms of injury, fracture classification, and underlying disease. Univariate and multivariate logistical regression analyses were performed to identify the predictors of the development of ACS following tibial plateau fractures. Results Of the 1119 fractures of the tibial plateau, 35 (3.1%) developed an acute compartment syndrome. On multivariate analysis, only younger patient age (odds ratio (OR) 2.57; 95% confidence interval (CI), 1.26 to 6.31; P = 0.003), and Schatzker VI type fracture (OR 5.78; 95% confidence interval (CI), 1.78 to 54.34; P = 0.021) were significantly associated with the development of ACS. Other variables did not reach statistical significance. Conclusion Younger patient age and Schatzker VI type fracture were predictors of ACS of the lower leg in adults following tibial plateau fractures. Further studies in the prospective study are still needed to identify the potential risk factors associated with ACS in tibial plateau fractures.

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Section: Introductionmentioning

confidence: 99%

Predictors of acute compartment syndrome of the lower leg in adults following tibial plateau fractures

Deng

et al. 2021

J Orthop Surg Res

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“…Nevertheless, our results showed duration of ischemia was not a risk factor for poor functional outcomes after surgery, which can be explained by compensatory collateral artery circulation from superficial femoral artery. It also needs to be noted collateral circulation blood supply will be affected under certain conditions, including compartment hypertension, complicated soft tissue injuries, occlusion of collateral artery pathways and unstable hemodynamics [ 19 , 21 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Five-year outcomes of trauma-specific function in patients after acute blunt popliteal artery injury: a matched cohort analysis

Liu

Zhou

2022

J Orthop Surg Res

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Background Few studies focus on the trauma-specific functional outcomes after surgical revascularization and risk factors contributing to poor outcomes in patients with acute blunt popliteal artery injury (PAI). The objective of this study was to investigate the long-term trauma-specific functional outcomes in patients with acute blunt PAI and identify the associated risk factors. Methods There were 36 patients with acute blunt PAI who require surgical revascularization at a national trauma center of West China Hospital of Sichuan University between March 2010 and April 2019. After propensity matching, each patient was matched to one patient who did not have a concomitant vascular injury in control cohort. Functional outcomes were assessed with trauma-specific functional scores, physical examination of range of motion, nerve functional status and knee stability. A logistics regression model was established to determine the independent risk factors. Results The 5-year (range 2–10 years) follow-up showed that 22 patients (22/36, 61.1%) had functional deficit due to limited activity or chronic neurological symptoms. Patients in vascular cohort had significantly decreased FIM score and AHFS score compared with matched patients without vascular involvement (P = 0.003 and P < 0.001), whereas there was no statistically significant difference in KSS (P = 0.136). Spearman correlation analysis of functional scores in vascular cohort showed that the FIM score was positively correlated with AHFS score (r = 0.926, P < 0.001), but not correlated with the KSS (r = − 0.007, P = 0.967). Additionally, there was significant difference in the range of motion of ankle between two groups (P < 0.001 and P = 0.034). Logistic regression analysis further demonstrated nerve injuries and compartment syndrome were risk factors for poor ankle function after surgery (OR 22.580, P = 0.036 and OR 12.674, P = 0.041). Conclusion Most patients who sustained blunt PAI had significant functional deficit associated with limited activity and chronic neurological symptoms of ankle and foot, and poor functional outcomes were related to nerve injury and compartment syndrome. Therefore, early and effective decompression for compartment syndrome remains the only potentially modifiable risk factor for improving functional outcomes following PAI.

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“…CS was least common in Schatzker type I and II fractures [26]. The two biggest radiographic predictors of CS were fracture length and fibular head fracture [26,28].…”

Section: Compartment Syndromementioning

confidence: 95%

“…Reduction and fixation of both plateaus is often necessary. These patients are at increased risk for neurovascular and soft tissue compromise [26][27][28]. The literature reports an incidence of 17-34% of compartment syndrome in this fracture pattern [25,26,29].…”

Section: Patient With Multitrauma and A Schatzker IV Fracture Seen Onmentioning

confidence: 99%

Tibial Plateau Fracture

Schmidt¹,

Szatkowski²,

Riehl³

2020

Tibia Pathology and Fractures

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Tibial plateau fractures are a common orthopedic injury. These fractures involve the articular surface of the tibia that is part of the knee joint. Plateau fractures can range from low energy injuries with little or no displacement to complex fractures with significant associated injuries. Stability of these injuries depends on a combination of bony and associated ligamentous injuries. Treatment consists of a wide spectrum of therapies which have been discussed in this chapter. Complications such as compartment syndrome, post-traumatic arthritis, chronic pain, malunion, and wound problems (in addition to other complications) can develop.

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Compartment Syndrome in Tibial Plateau Fractures: Do Previously Established Predictors Have External Validity?

Cited by 23 publications

References 17 publications

Predictors of acute compartment syndrome of the lower leg in adults following tibial plateau fractures

Predictors of acute compartment syndrome of the lower leg in adults following tibial plateau fractures

Five-year outcomes of trauma-specific function in patients after acute blunt popliteal artery injury: a matched cohort analysis

Tibial Plateau Fracture

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