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

Abstract

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.

Identifying key risk factors for acute compartment syndrome in tibial diaphysis fracture patients

“…Therefore, healthcare professionals should be aware of this gender difference and take it into account when assessing and managing patients with suspected or confirmed compartment syndrome. However, it is important to note that our study did not confirm previous findings 27 , 28 that age was significantly younger in the ACS group compared to the non-ACS group. One possible reason for this discrepancy could be that our study excluded patients under 18 years old, which could have influenced the results.…”

“…Our study's results are in agreement with the findings of these researchers, suggesting that high-energy trauma can lead to the development of ACS. The mechanism behind this correlation is believed to be related to the amount of energy that is initially dissipated in the soft tissues during the trauma, which can subsequently cause ischemia and tissue damage, leading to the onset of ACS 28 . In addition, it should be noted that the expansion of damaged tissue resulting from acute crush injuries or ischemic reperfusion can lead to intracompartmental swelling, which is a key factor in the development of ACS.…”

Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature

“…Abstract evaluation left 62 publications. After full-text examination of available studies, a total of 29 articles were kept for this review ( 10 , 24 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ). Among these only one article was found with the manual research ( 36 ).…”

“…Reported ACS occurrence in tibial plateau fractures reaches 12% and even 53% in higher-energy patterns ( 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ). In tibial shaft fractures, ACS occurrence reaches 11.5% ( 10 , 27 , 28 , 40 , 41 , 42 , 43 ).…”

Is the Presence of a Psychiatric Disorder Associated With More Aggressive Management of Compartment Syndrome?

“…Compartment syndrome is a clinical diagnosis; if present, the presence of muscle bulging or noted muscle necrosis on decompression is ultimately considered to be indicative of compartment syndrome. 11,12 However, such operative findings were inconsistently reported in our retrospective review of operative notes. Therefore, we chose to use the criteria previously established by McQueen et al and used the ability to close wounds within 48 hours as a surrogate for unnecessary fasciotomy and lack of compartment syndrome.…”