Acute Compartment Syndrome Research Articles

Novel perspectives on early diagnosis of acute compartment syndrome: the role of admission blood tests.

The role of admission blood indicators in patients with acute compartment syndrome (ACS) remains debated. Our primary purpose was to observe variations of admission blood indicators in patients with ACS, while our secondary goal was to explore potential biomarkers related to ACS. We collected information on patients with tibial fracture between January 2013 and July 2023, and divided them into ACS and non-ACS groups. Propensity score matching (PSM) analysis was performed to lower the impact of potential confounding variables such as demographics and comorbidities. Admission blood indicators were analyzed using univariate, logistic regression, and receiver operating characteristic (ROC) curve analyses. Then, we established a nomogram prediction model by using R language software. After propensity PSM analysis, 127 patients were included in each group. Although numerous blood indicators were found to be relevant to ACS on univariate analysis, logistic regression analysis showed that monocytes (MON, p = 0.015), systemic immune-inflammation index(SII, p = 0.011), and creatine kinase myocardial band (CKMB, p < 0.0001) were risk factorsfor ACS. Furthermore, ROC curve analysis identified 0.79×109/L, 1082.55, and 20.99U/L as the cut-off values to differentiate ACS patients from patients with tibial fracture. We also found that this combination had the highest diagnostic accuracy. Then, we constructed a nomogram prediction model with AUC of 0.869 for the prediction model, with good consistency in the correction curve and good clinical practicality by decision curve analysis. We found that the levels of MON, SII, and CKMB were related to ACS and may be potential biomarkers. We also identified their cut-off values to separate patients with ACS from those with tibial fracture, helping orthopedists promptly evaluate and take early measures. We established a nomogram prediction model that can efficiently predict ACS in patients with tibial fracture.

Patients with crush syndrome and kidney disease: lessons learned from the earthquake in Kahramanmaraş, Türkiye

This study investigated in-hospital outcomes and related factors in patients diagnosed with postearthquake crush syndrome after the earthquakes in Kahramanmaraş, Türkiye. One thousand twenty-four adult patients diagnosed with crush syndrome were analyzed. Data on demographic characteristics, clinical presentation, laboratory values, treatments, and outcomes were collected. A total of 9.8% of patients died during their hospital stay. Nonsurvivors were generally older, more likely to have preexisting chronic kidney disease, and faced more severe injuries and complications, including hypotension-shock, arrhythmias, elevated markers of renal dysfunction, and higher rates of acute kidney injury (AKI) and compartment syndrome. In addition, intensive care unit needs were higher. Multivariate analysis confirmed that age, injury severity, shock, high potassium, uric acid, and lactate levels on admission, development of AKI, compartment syndrome, and intensive care unit admission were significant predictors of mortality. Better disaster preparedness and improved health care infrastructure could be potential explanations for improved in-hospital mortality in the current era, as compared to previous earthquakes.

Acute compartment syndrome leading to fasciotomy, severe morbidity and long-term disabilities following Sri Lankan Green pit viper (Peltopelor trigonocephalus) envenomation

Acute compartment syndrome leading to fasciotomy, severe morbidity and long-term disabilities following Sri Lankan Green pit viper (Peltopelor trigonocephalus) envenomation

Epidemiology of Acute Compartment Syndrome After Pediatric Tibial Tubercle and Tibial Shaft Fractures.

While acute compartment syndrome (ACS) is a well-reported complication after pediatric tibial shaft fractures, prior literature has suggested that pediatric patients with tibial tubercle fractures may be at increased risk of ACS due to the proximity of the tibial tubercle to the anterior tibial recurrent artery. However, this theory was largely based on a series of early case reports without substantiation in larger-scale studies. The purpose of this study is to conduct a population-level analysis of the incidence and risk factors of acute compartment syndrome following pediatric tibial tubercle and tibial shaft fractures. We hypothesize that the rate of ACS would be lower in patients with tibial tubercle fractures when compared with those with tibial shaft fractures. A retrospective cohort analysis of the PearlDiver Mariner database was performed by querying all patients diagnosed with tibial tubercle and tibial shaft fractures between January 2010 and October 2022. Matched cohorts (n=25,483) of patients with pediatric tibial tubercle and tibial shaft fractures were captured using International Classification of Diseases, Ninth Revision (ICD-9), Tenth Revision (ICD-10) billing codes, and age as inclusion/exclusion criteria. Rates of subsequent compartment syndrome were calculated by querying for insurance claims with associated CPT codes for fasciotomy and/or ICD-9/ICD-10 billing codes for compartment syndrome. Student t test and χ2 analyses were used to compare demographics between the tibial tubercle and tibial shaft cohorts. The rate of ACS was significantly lower in the tibial tubercle cohort (0.46%) than in the tibial shaft cohort (0.70%, P<0.001). Male sex and increased age were associated with an increased risk of developing ACS in both cohorts (P<0.001). In addition, polytrauma was found to be a risk factor for ACS among patients with tibial shaft fractures (P<0.001). We report a low rate of ACS following both pediatric tibial tubercle fractures and pediatric tibial shaft fractures. Among patients with tibial tubercle fractures, male sex, and increased age were noted to be risk factors for ACS, whereas male sex, older age, and polytrauma were risk factors for ACS among patients with tibial shaft fractures.

High-Pressure Injection Injuries of the Hand: A Report of Three Cases Presenting With Acute Compartment Syndrome

High-Pressure Injection Injuries of the Hand: A Report of Three Cases Presenting With Acute Compartment Syndrome

Comparison of intracompartment pressure changes in tibial plateau fractures and controlled people: A pilot study.

Acute compartment syndrome (ACS) is a serious medical condition that can be encountered in tibial plateau fractures. However, no studies of compartment pressure changes in patients with tibial plateau fractures compared to patient without fractures have been reported. To obtain a comprehensive understanding of the pressure changes in patients with fractures, we monitored and recorded the compartment pressure and attempted to reveal the potential pressure release function of the human fascia. Cohorts of 43 normal individuals and 23 patients (initial 33, 10 were excluded due to inclusion criteria) and include the number of patients who completed the study with closed tibial fractures (the fracture group, FG, which comprised 6 men and 17 women) were included in this retrospective research. Compartment pressures were measured with Icare, a device that is traditionally used to measure intraocular pressure. Results of measurements at 6 different locations in the lower limb were recorded and compared for three days (days 2, 3, and 4 post fracture) between normal cohort (CG) and fracture cohort (FG) patients. The compartment pressures were comparable at each pressure measurement site (upper, middle and lower) in patients of the CG and the FG. Compared with the CG patients, there was a significant increase in compartment pressure at the upper lateral location in 18-45-year-old patients in the FG (P = 0.013) and at the upper lateral (P = 0.004) and medial locations (P = 0.005) in 46-69-year-old patients, and the values tended to normalize over time. Compared with the contralateral normal limb of patients in the FG, there was a significant increase in compartment pressure at the upper lateral location in 18-45-year-old patients (P = 0.009) and at the upper lateral (P = 0.015) and medial locations (P = 0.016) in 46-69-year-old patients on the fractured side. Based on different fracture classifications, there were no significant differences in compartment pressure at the medial (upper, middle and lower) locations when compared with pressures at the corresponding lateral sites of measurement. The results of this study revealed that the fascial compartment as a whole can release the increased intracompartment pressure after fracture to prevent complications such as acute compartment syndrome caused by a continued increase in pressure. The Icare as a portable device, is potentially useful in compartmental pressure measurement especially in emergency room.

Mechanism of minocycline activating Nrf2/Hmox1 pathway to prevent ferroptosis and alleviate acute compartment syndrome

BackgroundAcute compartment syndrome(ACS) is a perilous consequence of trauma. Acute compartment syndrome’s precise cause is yet unknown. We performed studies to confirm that acute compartment syndrome can be relieved by suppressing ferroptosis and activating the Nrf2/Hmox1 pathway.MethodsWe generated an ACS rat model and we conducted next-generation sequencing(NGS) of skeletal muscle tissue and identified differentially expressed target genes. Ultimately, we performed in vivo experiments to validate the presence of ferroptosis and the Nrf2/Hmox1 pathway in ACS rats. After the minocycline intervention, the drug was evaluated for its effects on ACS by examining changes associated with ferroptosis.ResultsThe bioinformatics analysis identified that the genetic changes in the disease were mostly focused on ferroptosis, with noticeable modifications in Nrf2/Hmox1. Based on the in vivo results, it was observed that ACS rats exhibited significantly elevated levels of ferroptosis compared to the control rats. The suppression of the Nrf2/Hmox1 pathway mediated by minocycline improves outcomes in ACS and reduces tissue damage after intervention.ConclusionMinocycline hinders ferroptosis via stimulating the Nrf2/Hmox1 pathway, which slows down the advancement of acute compartment syndrome.

"Navigating the tides of recovery": early vs. delayed osteosynthesis for closed tibia fractures complicated by acute compartment syndrome - an analysis of one hundred and three cases.

In cases of closed tibia fractures with acute compartment syndrome (ACS), there is no established agreement on whether performing internal fixation at the time of closure or after healing of the fasciotomy wounds would affect the likelihood of non-union or infection risk. The study aims to compare fracture union rates, incidence of infection, and overall outcomes between early and delayed definitive fixation. Retrospective analysis of closed tibia fractures (AO/OTA 41, 42) with ACS between 2010 and 2019 with a minimum two years follow-up. The patients were grouped into group-1 (early-definitive fixation group) and group-2 (delayed-definitive fixation group). The patients were further subdivided into - 1A(early-plate osteosynthesis), 1B(early-intramedullary nail fixation), 2A(delayed-plate osteosynthesis), and 2B(delayed-intramedullary nail fixation). Incidence of ACS in closed tibia fractures was 3.85%. Of the 103 patients included, the patients with plate fixation had a significantly higher union rate in the delayed group (100% vs. 91.66%; P = 0.0001). Similarly, among patients with nail fixation, a significantly higher union rate was seen in the delayed group (96.30% vs. 85.19%; P = 0.0016). The overall incidence of infection was 22.3% (23/103). Moreover, infection was higher in the early definitive fixation group (30.16% vs. 10%; P = 0.016). With a lower incidence of infection and higher union rate among the delayed definitive fixation group, we propose to postpone the definitive fixation of closed tibia fractures complicated by ACS till the complete healing of fasciotomy wounds. This allows for adequate soft tissue healing and improvement in the biological environment of fracture, which boosts the chances of successful union and reduces infection risks.

Lower limb acute onset muscle pain: what do we have to look for? A case of isolated rupture of the rectus femoris.

Acute muscle pain is muscle soreness that occurs during or within 24 hours of strenuous activity. Possible causes of acute muscle pain include localized muscle trauma, muscle tear, contusion with acute hemorrhage, or acute compartment syndrome. Isolated ruptures of the rectus femoris muscle are rare clinical conditions that result from excessive muscle strain following an abrupt contraction, incorrect movement, or sudden snap that exceeds the physiological limit of strain that the muscle can withstand. To date, there are few published reports evaluating the results of non-invasive treatment of such injuries. Herein, we report an unusual case of isolated distal rectus femoris tear in a 46-year-old female patient with no risk factors, who initially presented with extensor muscle weakness and pain and was treated conservatively with functional rest, physiotherapy, and cryotherapy.

Is the acute compartment syndrome diagnosed in snake bites true?: A review.

Envenomation caused by venomous snakes can induce clinical symptoms and signs resembling those of traumatic acute compartment syndrome (ACS), but it is uncertain whether its treatment guidelines are applicable or beneficial for ACS that is associated to snakebites. Nonetheless, recommendations for the diagnosis and treatment of trauma-induced ACS, particularly following fractures of the tibial diaphysis, are extrapolated to the diagnosis and treatment of snakebites despite evidence that the ensuing injuries are frequently not true ACS. Most biologists agree that the venom of snakes, especially those of the Crotalinae family (vipers) evolved to immobilize, kill, and initiate the digestion of their prey. The human local effects of viper envenoming are the result of digestion like those described in biological processes as acute pancreatitis, including secondary inflammatory and induction of reparative effects. The first-line treatment should focus on mitigation of venom-induced tissue digestion rather than surgery solution for "ACS-like" symptoms and signs. This type of analysis leads to questioning that treatment of ACS associated with snakebite cannot be extrapolated from recommendations formulated for trauma-induced ACS. The cornerstone of snake envenoming treatment is antivenom, and some clinical and experimental experiences start to show that surgical procedures frequently employed for trauma-induced ACS, such as debridement and fasciotomy, may be exaggerated and even deleterious in most viper bite envenoming.

Porcine blast injury model achieves prolonged elevation of intra-compartmental pressures without exogenous pressure manipulation

BackgroundMost existing animal models of acute compartment syndrome (ACS) rely on exogenous manipulation of intra-compartmental pressures to model ACS. The purpose of the current study was to evaluate the endogenous effect of a blast injury on porcine lower leg intra-compartmental pressures (ICP).MethodsThe hindlimb of juvenile Landrace pigs was fractured at the diaphyseal tibia and subjected to blasts of compressed air to mimic a blast injury. Injured and control legs underwent pre-operative continuous ICP monitoring. At 4.5 h post injury, the fracture was stabilized followed by closure of the anterior compartment fascia (continued compartment pressure model, CCPM) or four compartment fasciotomy. Pressure measurements were made after operative fixation. Select pigs in CCPM were harvested between 48 and 72 h post-injury to evaluate the duration of ICP elevation.ResultsPost-injury, the model created significantly elevated ICP compared to control limbs (54.5 ± 18.2 vs. 18.2 ± 4.9 mmHg; p < 0.001). Operative fixation and anterior compartment fascial closure further increased the ICP (Mean: 87.4 ± 42.5 mmHg) relative to the pre-operative state (p = 0.037). Fasciotomy returned baseline compartment pressures (Mean: 13.7 ± 10.2 mmHg) which were equivalent to control limbs (p = 0.117). Pressure measurements at the time of delayed harvest (48–72 h) demonstrated that elevated ICP persisted following injury (69.7 ± 55.12 mmHg).ConclusionThe current study demonstrates that a pilot porcine blast model elevates ICP comparable to existing animal models of compartment syndrome without exogenous ICP manipulation. ICP remained elevated at 48–72 h in the absence of fasciotomy.

Does regional anesthesia impact the frequency and timing of fasciotomy following surgical repair of lower leg fracture; A National Database Analysis

Study objectiveThere is controversy surrounding the use of regional anesthesia for the surgical repair of tibia and/or fibula fractures. In this study our goals are 1.) to describe the utilization of regional anesthesia for repair of lower leg fractures using a large nationally representative database; 2.) to compare the incidence of acute compartment syndrome (ACS) and need for fasciotomy following lower leg fracture surgery between patients who received nerve blocks and those that do not; 3.) compare the timing of postoperative fasciotomy between patients that received nerve blocks and those that do not. DesignRetrospective study of national administrative database. PatientsThe population of interest were patients who underwent surgery for repair of tibia and fibula fractures and subsequent fasciotomy from the Premier Healthcare database (Premier Healthcare Solutions, Inc., Charlotte, NC; 2006–2021. Surgical repair of tibia and fibula fractures as well as fasciotomies were identified using a standard set of international classification of diseases -ninth/tenth revision (ICD-9/10) codes. InterventionNone. MeasurementsThe Primary outcome was incidence of lower leg fasciotomy and/or compartment syndrome diagnoses following lower leg fracture repair surgery. We compared patients who received nerve blocks with those that did not receive nerve blocks. As a secondary outcome we compared the timing of fasciotomy after the index surgery between patients who received nerve block and those that did not receive a nerve block. Main resultsOur study population included 77,685 patients who underwent surgery for a tibia and/or fibula fracture, of which 5241 (6.7 %) patients had a nerve block. Overall, 3009 (3.9 %) of patients received an ACS diagnosis and 2448 (3.2 %) underwent a fasciotomy. Patients who did not receive a nerve block were more likely to receive a diagnosis of ACS (n = 2889), 4.0 % no block vs. n = 120, 2.3 % block p < 0.0001). Fasciotomies were performed more frequently in patients who did not receive a nerve block compared to those that did (n = 2359, 3.3 % no block vs. n = 89, 1.7 % p < 0.0001). The mean day of fasciotomy for patients who did not receive nerve blocks was 1.5 with 4.0 in patients who received nerve blocks (p < 0.001). ConclusionsNerve blocks are not widely used for postoperative analgesia following lower leg fracture surgery. The population of patients who receive nerve blocks is different than patients who do not receive nerve blocks. Nerve blocks were not associated with an increase in ACS diagnosis or fasciotomy.

The Analysis Study of Surgical Management and Outcome of Acute Compartment Syndrome: An Orthopaedic and Traumatology Systematic Review

Background: Acute compartment syndrome (ACS) is a serious medical condition that occurs when increased pressure within a closed muscle compartment reduces blood flow and can lead to permanent damage. This systematic review aims to analyze the management strategies, complications, and outcomes of acute compartment syndrome based on current literature. Methods: The review analyzed data from multiple studies, including both prospective and retrospective studies. Results: The analysis included eight studies with a total of 1,019 patients. Factors influencing outcomes in ACS included the time to fasciotomy, fracture status, muscle necrosis indicators, and patient-related factors. Early intervention and appropriate management were associated with better functional outcomes and reduced complications. Conclusion: Effective management of ACS relies heavily on timely intervention and proper post-surgical care. The studies reviewed highlight the importance of early fasciotomy and monitoring for complications to improve patient outcomes.

Primary closure of fasciotomies has a reduced complication rate following compartment syndrome in the paediatric population.

Currently no guidance exists within the literature regarding diagnostic criteria or the long-term outcomes for paediatric patients with acute compartment syndrome (ACS). We conducted a retrospective cohort study reviewing all cases of paediatric ACS managed at a single tertiary referral centre with the aim of characterising the factors responsible for the eventual outcomes. The patient cohort was identified retrospectively by interrogating the hospital coding system for all paediatric patients between January 2014 and November 2022. The electronic emergency department, inpatient and operative notes as well as clinic letters for each patient were reviewed and data collected regarding presentation, associated injuries, management and subsequent complications plus length of follow-up. The data was analysed to determine if differences in presentation or management affected long term outcome. The final cohort consisted of 34 patients with a mean age of tenyears at the time of presentation. The mean time from presentation to fasciotomy was 27.6h (range 3.0 - 66.6). There was an overall complication rate of 37.5% with a mean follow-up period of 21months. Patients who had direct closure of their fasciotomy wounds had a significantly lower complications rate and fewer operations compared to those who healed via other wound coverage methods or secondary intention (p < 0.05). Significantly higher complication rates were observed in patients who were unable to have direct wound closure following emergency fasciotomy. This information may be utilised to rationalise long term treatment plans and in counselling of patients and parents.

114: The Role of a Continuous Compartment Pressure Device in Managing Acute Compartment Syndrome in Patients Requiring Mechanical Circulatory Support

114: The Role of a Continuous Compartment Pressure Device in Managing Acute Compartment Syndrome in Patients Requiring Mechanical Circulatory Support

Imaging the intramuscular pressure of living muscles with shear waves

Shear wave elastography (SWE) is an innovative method that allows for the nondestructive and quantitative characterization of muscular mechanical properties. This method finds extensive utility in fields such as sports medicine, sports rehabilitation, and the diagnosis of muscle-related ailments. Existing studies have demonstrated the promise of SWE in probing intramuscular pressure (IMP), a factor intimately tied to muscular physiological functions and the onset of certain diseases. Nonetheless, there remains a lack of a SWE method grounded in an appropriate biomechanical model capable of effectively imaging IMP in vivo. Addressing this issue, we propose a shear wave imaging method relaying on a porohyperelastic model encompassing well-defined parameters for both muscular active behavior and intramuscular pressure. Drawing upon wave motion analysis, we establish a correlation between shear wave velocities and IMP in analytical form. This theoretical solution on one hand help understand the interplay between IMP and muscle active stress and the impact of muscle contraction on IMP. On the other hand, it enables us to develop an elastography method to assess IMP in vivo. We conducted a series of experiments to underscore the applicability of our theory and elastography method. Ex vivo experiments were performed on porcine muscles, while in vivo tests were carried out on human skeletal muscles. The results from the ex vivo tests validate the efficacy of our method. Meanwhile, the in vivo outcomes suggest that our approach holds potential to assess the variation of IMP with muscle fatigue and injuries, inspect intramuscular injections, and diagnose acute and chronic compartment syndrome.

Ultrasound Shear Wave Elastography for Noninvasive Diagnosis of Acute Compartment Syndrome Using a Novel In Vivo Turkey Model.

Acute Compartment Syndrome (ACS) is a severe trauma caused by elevated intra-muscle-compartment pressure (ICP). The current standard method for diagnosis is to insert a needle into the muscle sterilely under anesthesia. However, to secure the environment is sometimes not easy and leads to delays in diagnosis. Recently, we have focused on shear wave ultrasound elastography (SWE) as an alternative, which can be done concisely in unclean environment and without anesthesia. We would like to report the usefulness of SWE for ACS diagnosis using 2-pedal walking turkey model recently developed in our lab. A total of 32 1-year-old Bourbon turkeys were used. 5% solution of chicken albumin was infused continuously into the tibialis cranialis (TC) muscle using IV pump. The ICP was increased stepwise from 0 to 50 mmHg. During the rising of ICP, the correlation between values of SWE (kPa) and ICP (mmHg) was measured. After the ICP reached 50 mmHg, half of the turkeys were maintained at this pressure for 2 hours and the rest for 6 hours. After infusion, a fasciotomy was performed on the half turkey. Half of the turkeys were euthanized after 2 weeks and the rest after 6 weeks. SWE of TC muscle and walking gait data on turkeys using a portable walkway system were measured weekly until euthanasia. At euthanasia, isometric tetanic muscle force (ITF) tests to TC muscle and histological evaluations were performed. SWE value (kPa) was highly significantly correlated to the actual ICP (mmHg) (R2 = 0.91). Stance of ACS side leg were significantly extended, and swing of the control side shortened from the second to the third week after ACS in the 6 hours infusion-no-fasciotomy group (P < 0.05*). ITF was significantly reduced mainly in the 6 hours infusion group (P < 0.05*). Histological evaluation revealed that in the 6 hours infusion and 6 weeks survival group, both the muscle fiber and intercellular distances were significantly expanded (P < 0.05). SWE seems to be a substitute measure of ICP in diagnosing ACS. With regard to our in vivo ACS model using turkey, survival at 50 mmHg ICP for 6 hours and 6 weeks post ACS would be an appropriate situation.

Trauma Patients and Acute Compartment Syndrome: Is There an Ariadne's Thread That Can Safely Guide the Anesthesiologist/Emergency Physician Out of the Labyrinth?

Trauma patients in the emergency department experience severe pain that is not always easy to manage. The risk of acute compartment syndrome further complicates the analgesic approach. The purpose of this review is to discuss relevant bibliography and highlight current guidelines and recommendations for the safe practice of peripheral nerve blocks in this special group of patients. According to the recent bibliography, peripheral nerve blocks are not contraindicated in patients at risk of acute compartment syndrome, as long as there is surveillance and certain recommendations are followed.

Microfluidics as a Powerful Tool to Investigate Microvascular Dysfunction in Trauma Conditions: A Review of the State-of-the-Art.

Skeletal muscle trauma such as fracture or crush injury can result in a life-threatening condition called acute compartment syndrome (ACS), which involves elevated compartmental pressure within a closed osteo-fascial compartment, leading to collapse of the microvasculature and resulting in necrosis of the tissue due to ischemia. Diagnosis of ACS is complex and controversial due to the lack of standardized objective methods, which results in high rates of misdiagnosis/late diagnosis, leading to permanent neuro-muscular damage. ACS pathophysiology is poorly understood at a cellular level due to the lack of physiologically relevant models. In this context, microfluidics organ-on-chip systems (OOCs) provide an exciting opportunity to investigate the cellular mechanisms of microvascular dysfunction that leads to ACS. In this article, the state-of-the-art OOCs designs and strategies used to investigate microvasculature dysfunction mechanisms is reviewed. The differential effects of hemodynamic shear stress on endothelial cell characteristics such as morphology, permeability, and inflammation, all of which are altered during microvascular dysfunction is highlighted. The article then critically reviews the importance of microfluidics to investigate closely related microvascular pathologies that cause ACS. The article concludes by discussing potential biomarkers of ACS with a special emphasis on glycocalyx and providing a future perspective.

The Prevalence of Acute Compartment Syndrome in Pediatric Tibial Tubercle Fractures.

Tibial tubercle fractures are a unique class of pediatric orthopaedic injuries that frequently necessitate surgical treatment and strict monitoring due to the associated risk of acute compartment syndrome (ACS). However, current literature is conspicuously limited in its ability to estimate the risk of ACS after these fractures. Therefore, the purpose of this study is to utilize a nationwide database to estimate the prevalence of ACS after pediatric tibial tubercle fractures. We utilized the Healthcare Cost and Utilization Project's Kids' Inpatient Database (2019) to identify all pediatric patients, 18 years of age and under, with isolated tibial tubercle fractures (International Classification of Diseases, 10th revision Clinical Modification S82.151-S82.156) and ACS (T79.A0, T79.A2, T79.A29). Patients were excluded if they had additional lower extremity injuries (ie, tibial shaft, plateau, etc). A subanalysis was conducted for those undergoing fasciotomy, with and without an ACS diagnosis. Among the 591 isolated tibial tubercle fractures, there were 8 ACS cases for a prevalence of 1.35%. There were 22 (3.72%) additional cases of fasciotomy without an ACS diagnosis. All ACS cases were diagnosed during the original hospitalization; all were male and had closed fractures. The cohort included 469 teenagers (13+ years) and 77 pre-teens, with 40 females and 506 males. Racial demographics: 132 white, 232 black, 112 Hispanic, 15 Asian, 4 Native American, 23 unknown, and 28 others. No significant associations were found between ACS and age, race, insurance status, mechanism of injury, or hospital region. The rate of ACS in pediatric tibial tubercle fractures appears to be much lower than previously reported, at 1.35%. However, the nearly three-fold higher prevalence of fasciotomy without an ACS diagnosis, suggests a generous use of prophylactic fasciotomies and/or an undercharacterization of actual ACS cases from miscoding. This is the first and largest study to employ a nationally representative database to investigate the prevalence of ACS after tibial tubercle fractures. Level III.