The impact of acute compartment syndrome on the outcome of tibia plateau fracture

Thabet, Ahmed M.; Simson, Joshua E.; Gerzina, Chris; Dabash, Sherif; Adler, Adam J.; Abdelgawad, Amr

doi:10.1007/s00590-017-2017-6

Cited by 16 publications

(9 citation statements)

References 22 publications

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“…In addition to the fracture morphology, the influence of a relevant soft tissue injury in terms of compartment syndrome was shown. Thus far, different effects have been seen on this in other studies [27][28][29]. The number of previous diseases has a relevant influence on the KOOS subscore for ADL.…”

Section: Discussionmentioning

confidence: 85%

Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study

Henkelmann¹,

Glaab

Mende

et al. 2021

BMC Musculoskelet Disord

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Background Surgical site infection (SSI) occurs in 3–10 % of patients with surgically treated tibial plateau fractures. This study aimed to evaluate the impact of SSI on patients’ outcome after fixation of tibial plateau fractures. Methods We conducted a retrospective multicenter study in seven participating level I trauma centers between January 2005 and December 2014. All participating centers followed up with patients with SSI. In addition, three centers followed up with patients without SSI as a reference group. Descriptive data and follow-up data with patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Lysholm knee scoring scale score) were evaluated. Results In summary, 287 patients (41 with SSI and 246 without SSI; average 50.7 years) with an average follow-up of 75.9 ± 35.9 months were included in this study. Patients with SSI had a significantly poorer overall KOOS (KOOS5) (48.7 ± 23.2 versus [vs.] 71.5 ± 23.5; p < 0.001) and Lysholm knee scoring scale score (51.4 ± 24.0 vs. 71.4 ± 23.5; p < 0.001) than patients without SSI. This significant difference was also evident in the KOOS subscores for pain, symptoms, activities of daily living (ADL), and quality of life (QoL). SSI remained an important factor in multivariable models after adjusting for potential confounders. Clinically relevant differences in the KOOS5 and KOOS subscores for symptoms, pain, and ADL were found between those with SSI and without SSI even after adjustment. Furthermore, the number of previous diseases, Arbeitsgemeinschaft für Osteosynthesefragen Foundation (AO) C fractures, and compartment syndrome were found to be additional factors related to poor outcome. Conclusions Compared to previous studies, validated patient-reported outcome scores demonstrated that the impact of SSI in patients with surgically treated tibial plateau fractures is dramatic, in terms of not only pain and symptoms but also in ADL and QoL, compared to that in patients without SSI.

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Section: Discussionmentioning

confidence: 85%

Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study

Henkelmann¹,

Glaab

Mende

et al. 2021

BMC Musculoskelet Disord

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“…It is considered the most accurate method of measuring compartment pressures, allowing continuous monitoring. Serial and continuous ICP monitoring is recommended to avoid false-negative results associated with single normal ICP readings to confirm or exclude ACS [51][52][53]. Other less invasive techniques studied for measuring compartment blood flow include laser Doppler ultrasound, methoxy isobutyl isonitrile enhanced magnetic resonance imaging (MRI), phosphate-nuclear magnetic resonance (NMR) spectroscopy, thallous chloride-201 (201 Tl), and technetium-99 (99m Tc) sestamibi, and xenon (Xe) scanning [40].…”

Section: Diagnosismentioning

confidence: 99%

Coping With the Fear of Compartment Syndrome Without Compromising Analgesia: A Narrative Review

Sonawane¹,

Dhamotharan²,

Dixit³

et al. 2022

Cureus

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Pain management in trauma or surgery with a high risk of developing compartment syndrome (CS) is always challenging due to fears of masking symptoms that could delay diagnosis and treatment. Regional anesthesia/analgesia (RA) can facilitate enhanced postoperative recovery and improve patient satisfaction by providing excellent postoperative analgesia. However, its consideration in surgeries with a high risk of developing CS remains controversial and contentious. Studies suggest focusing more on early diagnosis through regular vigilant monitoring with a high index of suspicion rather than discontinuing the analgesic method alone. The most consistent features in all reported cases of CS were altered sensation in the affected limb, disproportionate pain in the presence of a functional nerve block, and an escalating need for analgesics.Several extrinsic or intrinsic factors are responsible for the progressive increase in compartment pressure that can lead to vascular compromise and subsequent ischemic changes in muscles, tissues, and nerves. Measurement of intracompartmental pressure (ICP) has always been considered the gold standard for diagnosing CS. An ICP of 30 mm Hg is considered the cut-off point for fasciotomy that helps restore muscle perfusion and avoid irreversible tissue damage. The chronology of symptoms can sometimes provide clues to the severity of CS, the pathophysiology involved, and the management required. Therefore, it is necessary to look for warning signs, further investigate the causes, and make quick decisions to diagnose and treat CS and its complications on time. Any delay in the diagnosis and treatment of CS can result in high morbidity and poor outcomes. A well-integrated interprofessional team of health professionals can deliver the required complexity of care through a holistic and multidisciplinary approach. This review article highlights the symptoms, risk factors, and pathophysiology involved in CS. It can guide readers in choosing various options to diagnose, prevent, and treat CS. It also discusses the role of RA in patients or surgeries prone to developing CS.

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“…Predictably, historical infection rates for tibial plateau fractures complicated by ACS have been estimated at 20%-25%. 3,[5][6][7][8] There are a number of techniques for lower extremity fasciotomies, which involve the safe release of all 4 lower extremity fascial compartments. 9 Dual-incision (DI) fasciotomy is the most ubiquitous technique.…”

Section: Introductionmentioning

confidence: 99%

Single-Incision Fasciotomy Decreases Infection Risk Compared with Dual-Incision Fasciotomy in Treatment of Tibial Plateau Fractures With Acute Compartment Syndrome

DeKeyser

Bunzel

O’Neill

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: Comparison of surgical site infection (SSI) rates in tibial plateau fractures with acute compartment syndrome treated with single-incision (SI) versus dual-incision (DI) fasciotomies. Design: Retrospective cohort study. Setting: Two, Level-1, academic, trauma centers. Patients: Between January 2001 and December 2021, one-hundred ninety patients with a diagnosis of tibial plateau fracture and acute compartment syndrome met inclusion criteria (SI: n = 127, DI: n = 63) with a minimum of 3-month follow-up after definitive fixation. Intervention: Emergent 4-compartment fasciotomy, using either SI or DI technique, and eventual plate and screw fixation of the tibial plateau. Outcomes: The primary outcome was SSI requiring surgical debridement. Secondary outcomes included nonunion, days to closure, method of skin closure, and time to SSI. Results: Both groups were similar in demographic variables and fracture characteristics (all P > 0.05). The overall infection rate was 25.8% (49 of 190), but the SI fasciotomy patients had significantly fewer SSIs compared with the DI fasciotomy patients [SI 18.1% vs. DI 41.3%; P < 0.001; OR 2.28, (confidence interval, 1.42–3.66)]. Patients with a dual (medial and lateral) surgical approach and DI fasciotomies developed an SSI in 60% (15 of 25) of cases compared with 21.3% (13 of 61) of cases in the SI group (P < 0.001). The nonunion rate was similar between the 2 groups (SI 8.3% vs. DI 10.3%; P = 0.78). The SI fasciotomy group required fewer debridement's (P = 0.04) until closure, but there was no difference in days until closure (SI 5.5 vs. DI 6.6; P = 0.09). There were zero cases of incomplete compartment release requiring return to the operating room. Conclusions: Patients with DI fasciotomies were more than twice as likely to develop an SSI compared with SI patients despite similar fracture and demographic characteristics between the groups. Orthopaedic surgeons should consider prioritizing SI fasciotomies in this setting. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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The impact of acute compartment syndrome on the outcome of tibia plateau fracture

Abstract: Level IV prognostic.

Cited by 16 publications

References 22 publications

Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study

Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study

Coping With the Fear of Compartment Syndrome Without Compromising Analgesia: A Narrative Review

Single-Incision Fasciotomy Decreases Infection Risk Compared with Dual-Incision Fasciotomy in Treatment of Tibial Plateau Fractures With Acute Compartment Syndrome

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