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

Xiangtian Deng,Hongzhi Hu,Zhipeng Ye,Jian Zhu,Yingze Zhang,Yiran Zhang

doi:10.1186/s13018-021-02660-7

Abstract

BackgroundAcute 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 methodsFrom 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.ResultsOf 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.ConclusionYounger 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.

Highlights

Tibial plateau fractures are intra-articular fractures that account for approximately 1.6% of all fractures associated with adults in China [1], which are generally accepted that carry a risk of various complications
Further studies in the prospective study are still needed to identify the potential risk factors associated with Acute compartment syndrome (ACS) in tibial plateau fractures
Univariate analysis identified that younger patient age and Schatzker type VI fracture (Fig. 2) were significantly associated with the development of ACS

Summary

Introduction

Tibial plateau fractures are intra-articular fractures that account for approximately 1.6% of all fractures associated with adults in China [1], which are generally accepted that carry a risk of various complications. Tibial plateau fractures are not commonly associated with ACS in adults, the knowledge of the prompt recognition, appropriate opportunity to emergency fasciotomy, and associated risk factors of ACS occurrence are important for orthopedic trauma surgeons. 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.

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