Medline ® Abstracts for References 4,5

We have analysed associated factors in 164 patients with acute compartment syndrome whom we treated over an eight-year period. In 69% there was an associated fracture, about half of which were of the tibial shaft. Most patients were men, usually under 35 years of age. Acute compartment syndrome of the forearm, with associated fracture of the distal end of the radius, was again seen most commonly in young men. Injury to soft tissues, without fracture, was the second most common cause of the syndrome and one-tenth of the patients had a bleeding disorder or were taking anticoagulant drugs. We found that young patients, especially men, were at risk of acute compartment syndrome after injury. When treating such injured patients, the diagnosis should be made early, utilising measurements of tissue pressure.

OBJECTIVES: To identify the incidence of acute compartment syndrome (ACS) in children and teenagers with tibial shaft fractures and report associated risk factors.

DESIGN: Retrospective Case Control.

SETTING: Level 1 pediatric trauma hospital.

PATIENTS/PARTICIPANTS: Two hundred sixteen tibial shaft fractures in 212 patients (160 males and 52 females; median age, 13 years) over a 5-year period were reviewed.

INTERVENTION: One hundred thirty-two (61%) fractures were treated with closed reduction and casting, 36 with external fixation, 27 with locked intramedullary nails, and 21 with flexible intramedullary nails.

MAIN OUTCOME MEASURES: ACS was diagnosed clinically or by intracompartment pressure. Multivariable logistic regression analysis tested age, gender, weight, physeal status, mechanism of injury, time to surgery, fracture type, and treatment intervention as possible risk factors for development of ACS.

RESULTS: There were 25 (11.6%) cases of ACS. Multivariable predictors of ACS included age of 14 years and older (22/96 = 23% vs. 3/120 = 3%, P<0.001) and motor vehicle accident (MVA) (13/57 = 23% vs. 12/159 = 8%, P<0.001). Incidence of ACS was 48% among patients aged 14 years and older, who sustained MVA (12/25). Gender, physeal status, time to surgery, and surgical fixation were not predictive of ACS.

CONCLUSIONS: This is the largest study in children and teenagers reporting the incidence of ACS from tibial shaft fractures. The incidence of 11.6% is higher than previously reported and much higher in patients older than14 years of age and involved in an MVA. Surgeons should be especially aware and suspicious of this diagnosis in teenagers with tibial shaft fractures.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.