Abstract
Background and objective:Tibia fractures are relatively common injuries that are accompanied with acute compartment syndrome in approximately 2% to 20% of cases. Although the shoe-lace technique, where vessel loops are threaded in a crisscross fashion and tightened daily, has been widely used, no studies have compared the shoe-lace technique with the conventional one. The aim of this study was to compare the shoe-lace technique with the conventional technique.Methods:We identified 359 consecutive patients with intramedullary nailed tibia fracture and complete medical records including outpatient data between April 2007 and April 2015 from electronic patient database of our institute. The use of the shoe-lace technique was compared to conventional one (in which wounds were first left open with moist dressings). Main outcome measurement is direct closure of fasciotomy wounds.Results:From 359 consecutive patients with intramedullary nailed tibia fracture, fasciotomy was performed on 68 (19%) patients. Of these, the shoe-lace technique was used in 47 (69%) patients while in 21 (31%) patients, the shoe-lace technique was not applied. Side-to-side approximation was successful in 36 patients (77%) in the shoe-lace+ group and 7 patients (33%) in the shoe-lace– group (p = 0.002).Conclusions:The main finding of our comparative study was that the shoe-lace technique seems to ease direct closure of lower leg fasciotomy wounds, and thus reduces the frequency of free skin grafts. Our finding needs to be confirmed in a high-quality randomized controlled trial.
Highlights
The Finnish Care Register for Health Care shows that, in Finland, approximately 1200 tibia fractures are operatively treated annually
Side-to-side approximation was successful in 36 patients (77%) in the shoe-lace+ group and 7 patients (33%) in the shoe-lace– group (p = 0.002)
The main finding of our comparative study was that the shoe-lace technique seems to ease direct closure of lower leg fasciotomy wounds, and reduces
Summary
The Finnish Care Register for Health Care shows that, in Finland, approximately 1200 tibia fractures are operatively treated annually (incidence 23/100,000 person-years). Tibia shaft fracture is associated with acute compartment syndrome (ACS) in approximately 2% to 20% of cases [1,2,3,4,5]. The risk factors for ACS can be divided to fracture-related and host-related. Host-related risk factors have been shown to be male gender, age below 55 years, arterial injury in the same leg and an Injury Severity Score (ISS) greater than 16 [2,6,7,8], and a diaphyseal fracture location as fracture-related risk [7]. Tibia fractures are relatively common injuries that are accompanied with acute compartment syndrome in approximately 2% to 20% of cases. The aim of this study was to compare the shoe-lace technique with the conventional technique
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