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Armbruster J, Steinhausen E, Hackl S, Reumann MK, Stengel D, Niemeyer F, Reiter G, Gruetzner PA, Freischmidt H. The Power of Heuristics in Predicting Fracture Nonunion. J Clin Med 2025; 14:2713. [PMID: 40283541 PMCID: PMC12028089 DOI: 10.3390/jcm14082713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Revised: 04/07/2025] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
Background/Objectives: Although extensive research on risk factors for nonunion development has been published, clinicians frequently rely on heuristic reasoning-intuitive, experience-based decision-making-to predict nonunions. However, the accuracy of these intuitive assessments and the influence of clinician experience remain uncertain. This study aims to assess clinicians' diagnostic accuracy in predicting nonunion, investigate the impact of experience on predictive performance, and identify patient-specific factors contributing to diagnostic errors. Methods: This retrospective, multi-center cohort study included 98 patients with surgically treated tibial shaft fractures between 2018 and 2023 from four level-one trauma centers in Germany. Fracture outcomes were classified as either nonunion (n = 20) or regular fracture healing (n = 78). Patient cases were presented to 24 clinicians. Each clinician independently assessed preoperative and postoperative biplanar X-rays and patient histories to predict fracture healing. Results: Clinicians' sensitivity significantly improved from 50.4% to 60.2%, while specificity declined (74.0% to 70.7%) with the addition of postoperative information. No significant differences in predictive performance were observed across different levels of clinician experience. Changes in assessment after reviewing postoperative information were equally likely to be beneficial or detrimental. Certain patient factors, including obesity and smoking, influenced prediction errors. Conclusions: This study is the first to assess heuristic reasoning in nonunion prediction. The findings suggest that clinician experience does not significantly enhance diagnostic accuracy under limited-information conditions. Patients should be informed that predicting individual nonunion risk remains challenging. Larger studies are needed to explore the role of patient-specific factors and refine clinical decision-making in fracture healing prognosis.
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Affiliation(s)
- Jonas Armbruster
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Eva Steinhausen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Simon Hackl
- Department of Trauma Surgery, BG Unfallklinik Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Marie K. Reumann
- Department for Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Klinik Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - Dirk Stengel
- BG Kliniken—Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117 Berlin, Germany
| | - Frank Niemeyer
- OSORA Medical GmbH, Industriestr. 10, 89231 Neu-Ulm, Germany
| | - Gregor Reiter
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Paul Alfred Gruetzner
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Holger Freischmidt
- BG Klinik Ludwigshafen, Department for Orthopaedics and Trauma Surgery, Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
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Alamoudi NB, AlJoaid R, Alaithan TM, Alqithmi M. Pathophysiology of an adolescent with compartment syndrome: a case report and review of the literature. J Med Case Rep 2025; 19:144. [PMID: 40148992 PMCID: PMC11951533 DOI: 10.1186/s13256-025-05189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 03/12/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Acute compartment syndrome occurs because of increased pressure within the fascial compartment, resulting in tissue ischemia. This surgical emergency, usually resulting from severe injury, is characterized by rapidly developing pain and swelling of the extremities. This case report aims to raise awareness among physicians by emphasizing the importance of high clinical sense in the diagnosis of compartment syndrome. CASE PRESENTATION This report describes a 25-year-old Saudi male who presented to the emergency department with a 1-week history of left leg pain. The pain suddenly worsened to severe anterior leg pain and swelling after he rapidly climbed multiple stairs. Acute compartment syndrome in the anterior compartment with rhabdomyolysis was diagnosed. Urgent fasciotomy was performed and the patient recovered gradually. CONCLUSION This report presents an exceptional case of acute myonecrosis in a patient with non-sickle cell disease, involving acute compartment syndrome in the anterior compartment, and rhabdomyolysis, which led to compartment syndrome.
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Affiliation(s)
- Naela B Alamoudi
- Emergency Medicine Department, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Rinad AlJoaid
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Mohammed Alqithmi
- Emergency Medicine Department, King Fahad Specialist Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
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Bastias GF, Abarca M. Foot and Ankle Complications after Tibial and Fibular Shaft Fractures. Foot Ankle Clin 2025; 30:201-220. [PMID: 39894615 DOI: 10.1016/j.fcl.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
The prevalence of foot and ankle injuries associated with tibial and fibular shaft fractures is estimated to be 25%. A myriad of injury mechanisms and surrounding soft tissue damage related to this type of fracture can lead to distal complications and sequelae in the foot and ankle. Early recognition of concomitant acute injuries and adequate management of delayed complications can optimize the functional outcomes and quality of life in most patients..
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Affiliation(s)
- Gonzalo F Bastias
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital Del Trabajador, Ramon Carnicer 185, Santiago, Chile.
| | - Mario Abarca
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital Del Trabajador - Clinica INDISA, Ramon Carnicer 185, Santiago, Chile
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Hu X, Wang P, Li C, Liu L, Wang X, Jin L, Zhao K, Wang L, Hou Z. Development and validation of the nomogram of high fascial compartment pressure with pilon fracture. INTERNATIONAL ORTHOPAEDICS 2025; 49:503-513. [PMID: 39774930 PMCID: PMC11762622 DOI: 10.1007/s00264-024-06402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 12/24/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE High Fascial Compartment Pressure (HCP) is one of the most common complications in ankle fractures. This study aimed to investigate the incidence of HCP in pilon fracture and analyze the risk factors of HCP in order to closely monitor its further development into Acute Compartment Syndrome. A nomogram is constructed and validated to predict HCP in patients with pilon fracture. METHODS We collected information on 1,863 patients with pilon fracture in the 3rd Hospital of Hebei Medical University Hospital from January 2019 to March 2024. Patients with HCP were assigned to the HCP group and those without HCP to the non-HCP group. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury types, and laboratory biomarkers. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with HCP. The selected predictors were then entered into R software for further analysis, and Nomogram construction. RESULTS The rate of HCP was 11.57%. Several predictors of HCP were found, including Body Mass Index (BMI) (p<0.001), Deep Vein Thrombosis (p < 0.001), occurrence of Fracture Blister (FB) (p < 0.001), use of Dehydrating Agent (p < 0.001), duration of limb immobilization (p < 0.001),and Systemic Immune-inflammation Index (SII) (p < 0.001). In addition, BMI (p < 0.001, OR 1.52, 95% CI 1.35 to 1.71), DVT (p < 0.001, OR 4.35, 95% CI 2.51 to 7.52), duration of limb immobilization (p < 0.01, OR 1.66, 95%CI 1.25 to 2.20) and SII (p < 0.01, OR 1.00, 95%CI 1.00 to 1.00) were correlated with increased HCP risk. Meanwhile, FB (p < 0.001, OR 0.23, 95% CI 0.13 to 0.39) and Dehydrating Agent (p < 0.001, OR 0.10, 95% CI 0.06 to 0.19) were associated with decreased HCP risk. The nomogram was established based on six predictors independently related to HCP. CONCLUSIONS Our investigation has shown that, compared with tibial diaphyseal fractures, pilon fractures are more prone to HCP because of their high energy injury characteristics. This research also shows BMI, DVT, occurrence of FB, use of Dehydrating Agent, duration of limb immobilization, and SII are independent risk factors for HCP in patients with pilon fracture. We have also devised a nomogram grounded in these identified predictors. In particular, this study found for the first time that SII is an independent risk factor for HCP, which provides a basis for clinical and basic science research on fascial immunology in the future.
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Affiliation(s)
- Xin Hu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Peiyuan Wang
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Chengsi Li
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Lin Liu
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Xin Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Lin Jin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Ling Wang
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
- Department of Orthopedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
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Lauer H, Heinzel JC, Vasselli B, Farzaliyev F, Ritter J, Kolbenschlag J, Daigeler A, Prahm C. Tendon Transfer Procedures for Correction of Foot Drop Due to Injury to the Peripheral Nerves or Muscles. J Brachial Plex Peripher Nerve Inj 2025; 20:e1-e8. [PMID: 39802981 PMCID: PMC11723794 DOI: 10.1055/s-0044-1801322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 12/03/2024] [Indexed: 01/16/2025] Open
Abstract
Background Foot drop is a challenging condition that significantly impacts the affected patient's mobility and quality of life. Tendon transfer has emerged as a viable treatment option. We hereby present data of the tendon transfer procedures in patients with foot drop in our department. Besides a detailed description of our surgical technique, we also compare our results with those reported in the literature. Methods Data from 17 patients (11 males and 6 females) suffering from foot drop due to peripheral nerve or muscle lesions were retrospectively analyzed. All the patients underwent tendon transfer procedures between 2017 and 2022. Assessed outcomes encompassed parameters such as strength of foot dorsiflexion, the necessity for postoperative orthotic devices, and patient satisfaction. Demographic data, the time elapsed from injury/illness to surgery, and the underlying causes of foot drop were collected. Results Postsurgery, 14 patients regained robust dorsiflexion strength (M4), while 2 exhibited slightly lower strength (M3) and 1 attained equal strength as on the unaffected side (M5). Corrective procedures were undertaken in five patients to address problems with tendon tension. After an average follow-up period of 11.9 months (± 9.13), 82.4% of patients reported a high level of satisfaction, although three patients experienced persistent foot inversion. Most patients (94.1%) no longer required orthotic devices following the operative procedure. Conclusion A tendon transfer procedure for correction of foot drop has proven to be a safe and effective treatment option, resulting in a high level of patient satisfaction and restoration of quality of life.
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Affiliation(s)
- Henrik Lauer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
| | - Johannes Christoph Heinzel
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
| | - Benedetta Vasselli
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
| | - Farhad Farzaliyev
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
| | - Jana Ritter
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
| | - Cosima Prahm
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tübingen, Tübingen, Germany
- Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Germany
- Department of Hand, Replantation and Microsurgery, Charité University Medicine, Berlin, Germany
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Strain R, Giannoudis P. Risk factors for acute compartment syndrome in one thousand one hundred and forty seven diaphyseal tibia fractures. INTERNATIONAL ORTHOPAEDICS 2024; 48:2211-2216. [PMID: 38888756 PMCID: PMC11246290 DOI: 10.1007/s00264-024-06235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Acute compartment syndrome (ACS) remains a devastating complication of orthopaedic trauma. The tibial diaphysis is especially implicated in the development of ACS, both at the time of injury and after operative management. Identification of risk factors for ACS for these distinct scenarios has been investigated in a large cohort of patients. METHODS This is a retrospective cohort study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. ACS was determined by a combination of clinical signs and symptoms and compartmental pressure monitoring. Potential risk factors were subject to univariate analysis with significant variables undergoing binary logistic regression analysis. RESULTS 1147 tibial diaphyseal fractures over a twelve year period were studied. Age, multifragmented fracture pattern, male gender, high energy mechanism and intra- articular extension all showed a statistically significant association for ACS. Increasing body mass index (BMI) and treatment with an intramedullary nail favoured development of ACS post-operatively. CONCLUSION Risk factors for the development of ACS specifically in tibial diaphyseal fractures have been highlighted. Patients managed with IMN or high BMI may warrant particular observation following operative intervention.
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Affiliation(s)
- Ritchie Strain
- Academic Department of Trauma & Orthopaedics, School of Medicine, Level D, University of Leeds, Clarendon WingGreat George Street, Leeds, West Yorkshire, LS1 3EX, UK.
- Leeds General Infirmary, Leeds, UK.
| | - Peter Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, Level D, University of Leeds, Clarendon WingGreat George Street, Leeds, West Yorkshire, LS1 3EX, UK
- Leeds General Infirmary, Leeds, UK
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Light JJ, Davis JM, Dunahoe J, Stwalley D, Miller AN, Cannada LK. Evaluation of obesity and age as a predictive factor of lower extremity compartment syndrome: A national trauma data bank analysis. Am J Surg 2024; 234:129-135. [PMID: 38653707 PMCID: PMC11223954 DOI: 10.1016/j.amjsurg.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Risk factors of acute compartment syndrome (ACS) of the leg include tibial fractures followed by soft tissue injuries. METHODS Data collected from the National Trauma Data Bank (NTDB) between 2017 and 2019 were analyzed for adult patients with lower extremity fractures, including proximal tibia, tibial shaft, and distal tibia. The primary outcome was a diagnosis of ACS. RESULTS There were 1052/220,868 patients with lower extremity fractures with a concomitant diagnosis of compartment syndrome. Our study has shown that patients with a BMI of ≥30 had a lower incidence of compartment syndrome when compared with patients with a BMI of 25-29 and controlled for fracture type. Increased age ≥55 in males, and females between 65 and 84, also demonstrated a decreased risk. Proximal tibial fractures (n = 54,696) were significantly associated with ACS compared to midshaft (n = 42,153) and distal (n = 100,432), p < 0.0001. CONCLUSION We found that being overweight decreases risk for development of compartment syndrome in patients with lower extremity fractures. This big data study aids in establishing risk factors for development of ACS in adult trauma patients.
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Affiliation(s)
| | - Jana M Davis
- Penn State College of Medicine, M.S. Hershey Medical Center, Hershey, PA, USA
| | - Jackie Dunahoe
- Washington University Department of Orthopaedic Surgery, St. Louis, MO, USA
| | - Dustin Stwalley
- Washington University Institute for Informatics, Data Sciences and Biostatistics, St. Louis, MO, USA
| | - Anna N Miller
- Washington University Department of Orthopaedic Surgery, St. Louis, MO, USA
| | - Lisa K Cannada
- Novant Health Orthopaedic Fracture Clinic, University of North Carolina School of Medicine, Charlotte Campus, Charlotte, NC, USA.
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Kakalecik J, Satchell C, Root KT, Vasilopoulos T, Patrick MR, Talerico MT, Krupko TA, Nin O, Hagen JE. Relationship Between Perioperative Regional Anesthesia and the Risk of Missing Acute Compartment Syndrome Following Tibia Fractures. Anesth Analg 2024:00000539-990000000-00858. [PMID: 38941266 DOI: 10.1213/ane.0000000000007084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
BACKGROUND The aim of this study was to determine the incidence of missed compartment syndrome in tibia fractures treated with and without regional anesthesia. METHODS A retrospective chart review was performed of patients with operative tibial shaft or plateau fractures at a single level-one trauma hospital between January 2015 and April 2022 with a minimum of 3-month follow-up. Patients under 18 years of age, an ipsilateral knee dislocation, known neurologic injury at presentation, or prophylactic fasciotomy were excluded. We defined missed acute compartment syndrome (ACS) as a postinjury motor deficit still present at the 3-month postoperative appointment. For patients that received a peripheral nerve block, we recorded whether a continuous perineural catheter or one-time single-shot injection was performed, and the number of nerves blocked. Incidence rates for ACS were calculated with exact binomial 95% confidence intervals (CIs). Morphine milligram equivalents (MMEs) consumed 24 hours after surgery, use of nerve block, nerve block timing, and type of block were compared using Mann-Whitney and Kruskal-Wallis nonparametric tests. Statistical significance was defined as P < .05. RESULTS The incidence of compartment syndrome diagnosed and treated during index hospitalization was 2.2% (17/791, 95% CI, 1.3%-3.4%). The incidence of missed ACS was 0.9% (7/791, 95% CI, 0.4%-1.8%). The incidence of missed ACS was not different between those who received nerve block 0.7% (4/610, 95% CI, 0.2%-1.7%), and those who did not (1.7% (3/176, 95% CI, 0.4%-4.8%) P = .19). Within patients receiving a nerve block, all patients with missed ACS (n = 4) received a perineural catheter. Similar missed ACS rates were observed between tibial shaft and plateau fractures. Patients receiving a nerve block had lower MME compared to those who did not receive a nerve block (P < .001). CONCLUSIONS The results do not provide evidence that perioperative regional anesthesia increases the incidence of missed ACS in patients with operative tibial shaft or plateau injuries. but does decrease postoperative opioid requirements.
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Affiliation(s)
- Jaquelyn Kakalecik
- From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Christopher Satchell
- From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Kevin T Root
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Terrie Vasilopoulos
- From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Matthew R Patrick
- From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Michael T Talerico
- From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - Thomas A Krupko
- From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
| | - OlgaC Nin
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Jennifer E Hagen
- From the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida
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Bhogadi SK, El-Qawaqzeh K, Colosimo C, Hosseinpour H, Magnotti LJ, Spencer AL, Anand T, Ditillo M, Alizai Q, Nelson A, Joseph B. Pediatric Acute Compartment Syndrome in Long Bone Fractures: Who is at Risk? J Surg Res 2024; 298:53-62. [PMID: 38569424 DOI: 10.1016/j.jss.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION There is a paucity of large-scale data on the factors that suggest an impending or underlying extremity pediatric acute compartment syndrome (ACS). In addition, literature regarding the timing of operative fixation and the risk of ACS is mixed. We aimed to describe the factors associated with pediatric ACS. METHODS Analysis of 2017-2019 Trauma Quality Improvement Program. We included patients aged <18 y diagnosed with upper extremity (UE) and lower extremity (LE) fractures. Burns and insect bites/stings were excluded. Multivariable regression analyses were performed to identify the predictors of ACS. RESULTS 61,537 had LE fractures, of which 0.5% developed ACS. 76,216 had UE fractures, of which 0.16% developed ACS. Multivariable regression analyses identified increasing age, male gender, motorcycle collision, and pedestrian struck mechanisms of injury, comminuted and open fractures, tibial and concurrent tibial and fibular fractures, forearm fractures, and operative fixation as predictors of ACS (P value <0.05). Among LE fractures, 34% underwent open reduction internal fixation (time to operation = 14 [8-20] hours), and 2.1% underwent ExFix (time to operation = 9 [4-17] hours). Among UE fractures, 54% underwent open reduction internal fixation (time to operation = 11 [6-16] hours), and 1.9% underwent ExFix (time to operation = 9 [4-14] hours). Every hour delay in operative fixation of UE and LE fractures was associated with a 0.4% increase in the adjusted odds of ACS (P value <0.05). CONCLUSIONS Our results may aid clinicians in recognizing children who are "at risk" for ACS. Future studies are warranted to explore the optimal timing for the operative fixation of long bone fractures to minimize the risk of pediatric ACS.
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Affiliation(s)
- Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Khaled El-Qawaqzeh
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Christina Colosimo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Audrey L Spencer
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Tanya Anand
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Michael Ditillo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Qaidar Alizai
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Adam Nelson
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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10
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An M, Jia R, Wu L, Ma L, Qi H, Long Y. Identifying key risk factors for acute compartment syndrome in tibial diaphysis fracture patients. Sci Rep 2024; 14:8913. [PMID: 38632464 PMCID: PMC11024173 DOI: 10.1038/s41598-024-59669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p < 0.001, OR = 1.003), and white blood cell (WBC) count (p < 0.001, OR = 1.246). Interestingly, the study also found that certain factors, such as falls on the same level (p = 0.007, OR = 0.334) and cholinesterase (CHE) levels (p < 0.001, OR = 0.721), seem to provide a degree of protection against ACS. In order to better predict ACS, the ROC curve analysis was employed, which determined threshold values for LDH and WBC. The established cut-off points were set at 266.26 U/L for LDH and 11.7 × 109 cells per liter for WBC, respectively. Our research has successfully pinpointed gender, crush injuries, LDH levels, and white blood cell (WBC) count as crucial risk factors for the development of ACS in patients experiencing tibial diaphysis fractures. Furthermore, by establishing the cut-off values for LDH and WBC, we have facilitated a more personalized assessment of ACS risk, enabling clinical doctors to implement targeted early interventions and optimize patient outcomes.
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Affiliation(s)
- Ming An
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Ruili Jia
- Department of Nephrology, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Limei Wu
- Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050000, China
| | - Leilei Ma
- Department of Burns and Plastic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Hui Qi
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China.
| | - Yubin Long
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China.
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Honkonen EE, Repo JP, Lehtokangas H, Luoma E, Uimonen M, Nurmi S, Ylitalo A, Riuttanen A, Kivelä T, Mattila VM, Suomalainen P. Suprapatellar tibial fracture nailing is associated with lower rate for acute compartment syndrome and the need for fasciotomy compared with the infrapatellar approach. J Orthop Traumatol 2024; 25:5. [PMID: 38282098 PMCID: PMC10822828 DOI: 10.1186/s10195-024-00749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Intramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach. PURPOSE The aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches. METHODS A total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies. RESULTS The study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p < 0.001). There were no significant differences in the fracture morphology or patient demographics between the study groups. CONCLUSIONS The suprapatellar technique is recommended over the infrapatellar approach in the treatment of tibial shaft fractures. The rate of peri- and postoperative compartment syndrome and the need for fasciotomies was significantly lower with the suprapatellar technique. The major cause of increased rate of peri- or postoperative acute compartment syndrome with infrapatellar IMN technique is presumably associated with the positioning of the patient during the operation. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Essi E Honkonen
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland.
| | - Jussi P Repo
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Heidi Lehtokangas
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Emma Luoma
- Department of Surgery, Central Finland Central Hospital, Nova Hospital, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Mikko Uimonen
- Department of Surgery, Central Finland Central Hospital, Nova Hospital, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Sami Nurmi
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Antti Ylitalo
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Antti Riuttanen
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Tiia Kivelä
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Ville M Mattila
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
| | - Piia Suomalainen
- Unit of Musculoskeletal Surgery, Department of Orthopaedics and Traumatology, Tampere University Hospital, Elämänaukio 2, PL 272, 33521, Tampere, Finland
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Mittlmeier AS, Pape HC, Neuhaus V, Canal C. The impact of fasciotomy on inpatient outcomes in lower leg fracture management. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:363-369. [PMID: 37535098 PMCID: PMC10771594 DOI: 10.1007/s00590-023-03666-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND While lower extremity fractures are common injuries, concomitant compartment syndrome can lead to significant implications and surgical release (fasciotomy) is essential. The aim of this study was to identify potential predictors of compartment release and risk factors related to complications. Using a large nationwide cohort, this study compared patients suffering from lower extremity fractures with and without compartment syndrome during their primary in-hospital stay following trauma. METHODS A retrospective analysis was conducted using the prospective surgical registry of the working group for quality assurance in surgery in Switzerland, which collects data from nearly 85% of all institutions involved in trauma surgery. Inclusion criteria Patients who underwent surgical treatment for tibia and/or fibula fractures between January 2012 and December 2022 were included in the study. Statistics Statistical analysis was performed using Chi-square, Fisher's exact test, and t test. Furthermore, a regression analysis was conducted to determine the independent risk factors for fasciotomy and related complications. In the present study, a p value less than 0.001 was determined to indicate statistical significance due to the large sample size. RESULTS The total number of cases analyzed was 1784, of which 98 underwent fasciotomies and 1686 did not undergo the procedure. Patients with fasciotomies were identified as significantly younger (39 vs. 43 years old) and mostly male (85% vs. 64%), with a significantly higher American Society of Anesthesiologists (ASA) score (ASA III 10% vs. 6%) and significantly more comorbidities (30% vs. 20%). These patients had significantly longer duration of surgeries (136 vs. 102 min). Furthermore, the total number of surgical interventions, the rate of antibiotic treatment, and related complications were significantly higher in the fasciotomy group. Sex, age, comorbidities, and fracture type (both bones fractured) were identified as relevant predictors for fasciotomy, while ASA class was the only predictor for in-hospital complications. Outcomes Patients who underwent fasciotomy had a significantly longer hospital stay (18 vs. 9 days) and a higher complication rate (42% vs. 6%) compared to those without fasciotomy. While fasciotomy may have played a role, other factors such as variations in patient characteristics and injury mechanisms may also contribute. Additionally, in-house mortality was found to be 0.17%, with no patient death recorded for the fasciotomy group. CONCLUSIONS Fasciotomy is vital. The knowledge about the further course is, however, helpful in resource allocation. We found significant differences between patients with and without fasciotomy in terms of age, sex, complication rate, length of stay, comorbidities, duration of operations, and use of antibiotics during their primary in-hospital stay. While the severity of the underlying trauma could not be modulated, awareness of the most relevant predictors for fasciotomy and related complications might help mitigate severe consequences and avoid adverse outcomes.
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Affiliation(s)
- Anne Sophie Mittlmeier
- Division of Trauma Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, 8091, Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, 8091, Zurich, Switzerland
| | - Claudio Canal
- Division of Trauma Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, 8091, Zurich, Switzerland.
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Schwartz L, Ganta A, Konda S, Leucht P, Rivero S, Egol KA. Tibial Plateau Fracture Surgical Care Using Standardized Protocols Over Time: A Single Center's Longitudinal View. J Orthop Trauma 2023; 37:627-632. [PMID: 37797328 DOI: 10.1097/bot.0000000000002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To report on demographics, injury patterns, management strategies, and outcomes of patients who sustained fractures of the tibial plateau seen at a single center over a 16-year period. DESIGN Prospective collection of data. PATIENTS/PARTICIPANTS 716 patients with 725 tibial plateau fractures, were treated by one of 5 surgeons. INTERVENTION Treatment of tibial plateau fractures. MAIN OUTCOME MEASUREMENTS Outcomes were obtained at standard time-points. Complications were recorded. Patients were stratified into 3 groups: those treated in the first 5 years, those treated in the second 5 years, and those treated in the most recent 6 years. RESULTS Six hundred eight fractures were followed for a mean 13.4 months (6-120) and 82% had a minimum 1-year follow-up. Patients returned to self-reported baseline function at a consistent proportion during the 3 time periods. The average knee arc was 125 degrees (75-135 degrees) at latest follow-up and did not differ over time. The overall complication rate after surgery was 12% and did not differ between time periods. Radiographs demonstrated excellent rates of healing and low rates of post-traumatic osteoarthritis and improved articular reductions at healing (0.58 mm in Group 3 compared with 0.94 mm in Group 1 and 1.12 mm in Group 2) ( P < 0.05). CONCLUSIONS Most patients regained their baseline functional status after surgical intervention and healing. Over time the ability of surgeons to achieve a more anatomic joint reduction was observed; however, this did not correlate with improved functional outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Luke Schwartz
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY; and
- Jamaica Hospital Medical Center, Jamaica, Queens, NY
| | - Abhishek Ganta
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY; and
- Jamaica Hospital Medical Center, Jamaica, Queens, NY
| | - Sanjit Konda
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY; and
- Jamaica Hospital Medical Center, Jamaica, Queens, NY
| | - Philipp Leucht
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY; and
- Jamaica Hospital Medical Center, Jamaica, Queens, NY
| | - Steven Rivero
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY; and
| | - Kenneth A Egol
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY; and
- Jamaica Hospital Medical Center, Jamaica, Queens, NY
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14
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Yang S, Wang T, Long Y, Jin L, Zhao K, Zhang J, Guo J, Hou Z. The impact of both-bone forearm fractures on acute compartment syndrome: An analysis of predisposing factors. Injury 2023; 54:110904. [PMID: 37394329 DOI: 10.1016/j.injury.2023.110904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Acute compartment syndrome (ACS) is a severe medical condition that, if left untreated, can cause permanent nerve and muscle damage, and may even require amputation. The objective of this study was to identify the risk factors associated with the development of ACS in patients with both-bone fractures of the forearm. METHODS Between November 2013 and January 2021, a retrospective data collection was conducted on 611 individuals who experienced both-bone forearm fractures at a level 1 trauma center. Among these patients, 78 patients were diagnosed with ACS, while the remaining 533 patients did not have ACS. Based on this division, the patients were categorized into two groups: the ACS group and the non-ACS group. Demographics (including factors such as age, gender, body mass index, crush injury, etc.), comorbidities (including conditions such as diabetes, hypertension, heart disease, anemia, etc.), and admission lab results (including complete blood count, comprehensive metabolic panel, and coagulation profiles, etc.) were analyzed using univariate analysis, logistic regression, and ROC curve analysis. RESULTS Predictors of ACS were identified through the final multivariable logistic regression analysis, which revealed that crush injury (p < 0.001, OR = 10.930), the levels of neutrophils (NEU) (p < 0.001, OR = 1.338) and the levels of creatine kinase (CK) (p < 0.001, OR = 1.001) were significant risk factors. Additionally, age (p = 0.045, OR = 0.978) and albumin (ALB) level (p < 0.001, OR = 0.798) were found to provide protective effects against ACS. Furthermore, the receiver operating characteristic (ROC) curve analysis determined cut-off values for NEU and CK to predict ACS: 7.01/L and 669.1 U/L respectively. CONCLUSIONS Our study identified crush injury, NEU, and CK as significant risk factors for ACS in patients with both-bone forearm fractures. We also determined the cut-off values of NEU and CK, allowing for the individualized evaluation of ACS risk and the implementation of early targeted treatments.
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Affiliation(s)
- Shuo Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Tao Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Yubin Long
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China; The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei, China
| | - Lin Jin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China
| | - Jiaqi Zhang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Junfei Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, China; NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, Hebei, China.
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15
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Farah O, Farah G, Mumuni S, Volchenko E, Hutchinson MR. Acute Compartment Syndrome in the Athlete. Clin Sports Med 2023; 42:525-538. [PMID: 37208063 DOI: 10.1016/j.csm.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In sports, acute compartment syndrome (ACS) develops following lower limb fracture, with subsequent high intracompartmental pressures and pain out of proportion to the physical examination. A prompt diagnosis is the key to a successful outcome in patients with ACS. The goal of treatment of ACS, namely decompressive fasciotomy, is to reduce intracompartmental pressure and facilitate reperfusion of ischemic tissue before onset of necrosis. A delay in diagnosis and treatment may result in devastating complications, including permanent sensory and motor deficits, contractures, infection, systemic organ failure, limb amputation, and death.
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Affiliation(s)
- Omar Farah
- Columbia University Vagelos College of Physicians and Surgeons
| | - Ghassan Farah
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA
| | - Salma Mumuni
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA
| | - Elan Volchenko
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA
| | - Mark R Hutchinson
- Department of Orthopaedic Surgery, University of Illinois, Chicago, USA.
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Samet RE, Torrie AM, Chembrovich SV, Ihnatsenka BV. Pro-Con Debate: Peripheral Nerve Blockade Should Be Provided Routinely in Extremity Trauma, Including in Patients At Risk for Acute Compartment Syndrome. Anesth Analg 2023; 136:855-860. [PMID: 37058722 DOI: 10.1213/ane.0000000000006394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
In this Pro-Con commentary article, we discuss the controversial debate of whether to provide peripheral nerve blockade (PNB) to patients at risk of acute extremity compartment syndrome (ACS). Traditionally, most practitioners adopt the conservative approach and withhold regional anesthetics for fear of masking an ACS (Con). Recent case reports and new scientific theory, however, demonstrate that modified PNB can be safe and advantageous in these patients (Pro). This article elucidates the arguments based on a better understanding of relevant pathophysiology, neural pathways, personnel and institutional limitations, and PNB adaptations in these patients.
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Affiliation(s)
- Ron E Samet
- From the Department of Anesthesiology, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Arissa M Torrie
- From the Department of Anesthesiology, University of Maryland School of Medicine, R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Svetlana V Chembrovich
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Barys V Ihnatsenka
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
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17
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Haase DR, Haase LR, Moon TJ, Mersereau EJ, Napora JK, Wise BT. Radiographic parameters associated with fracture-related infection in high energy bicondylar tibial plateau fractures managed with two-stage treatment: Identifying the bad actors. Injury 2023:S0020-1383(23)00384-4. [PMID: 37156699 DOI: 10.1016/j.injury.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION High energy tibial plateau fractures are fraught with complications, particularly fracture-related infection (FRI). Previous studies have evaluated patient demographics, fracture classification, and injury characteristics as risk factors for FRI in patients with these injuries. This study evaluated the relationship between radiographic parameters (fracture length relative to femoral condyle width (FLF ratio), initial femoral displacement (FD ratio), and tibial widening (TW ratio)) and fracture-related infection following internal fixation in high energy bicondylar tibial plateau fractures. METHODS 225 patients treated for bicondylar tibial plateau fractures at two level I trauma centers were retrospectively reviewed. Patient characteristics, fracture classification, and radiographic measurements were analyzed to determine association with FRI. RESULTS The rate of FRI was 13.8%. Increased fracture length, FLF ratio, FD ratio, TW ratio, and fibula fracture were each associated with FRI on regression analysis, independent of clinical variables. Cutoff values were identified for each parameter and patients were risk stratified based on these radiographic parameters. High-risk patients had a 2.68- and 12.36-times risk of FRI compared to medium and low-risk patients, respectively. DISCUSSION This study is the first to examine the relationship between radiographic parameters and FRI in high energy bicondylar tibial plateau fractures. Fracture length, FLF ratio, FD ratio, TW ratio, and fibula fracture were identified as radiographic parameters associated with FRI. More importantly, risk stratifying patients based on these parameters accurately identified patients at increased risk of FRI. Not all bicondylar tibial plateau fractures are created equal and radiographic parameters can be utilized to help identify the bad actors.
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Affiliation(s)
- Douglas R Haase
- Resident in Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Lucas R Haase
- Resident in Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Tyler J Moon
- Resident in Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Erik J Mersereau
- Resident in Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Joshua K Napora
- Assistant Professor of Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Brent T Wise
- Assistant Professor of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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Wang T, Guo J, Long Y, Hou Z. Predictors of acute compartment syndrome in patients with tibial fractures: a meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:51-65. [PMID: 36450888 DOI: 10.1007/s00264-022-05643-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/12/2022] [Indexed: 12/04/2022]
Abstract
STUDY DESIGN This is the first meta-analysis focusing on the risk factors related to ACS after tibial fractures. BACKGROUND Acute compartment syndrome (ACS) is a serious complication that affects 2-9% of tibial fracture patients. It is importance of identifying the predictors of ACS in patients with tibial fractures. QUESTIONS/PURPOSES We performed a meta-analysis to identify the risk factors of ACS after tibial fracture. METHODS We searched articles in the English databases, such as PubMed, Embase, and the Cochrane Library and the Chinese databases including CNKI and WAN FANG. We collected data related to ACS from included studies and analyzed data by RevMan 5.3 and STATA 12.0. RESULTS The rate of ACS was 2.7% (10,708 of 398,414 patients) from 16 included articles. Our data showed that younger age (p < 0.00001, OR = - 7.93, 95% CI [- 9.34, - 6.25]), male patients (p < 0.00001, OR = 2.17, 95% CI [2.07, 2.28]), patients without a history of hypertension (p < 0.00001, OR = 0.69, 95% CI [0.64, 0.74]), with a history of smoking (p < 0.00001, OR = 1.38, 95% CI [1.30, 1.46]), and patients with fibular fractures (p = 0.001, OR = 2.68, 95% CI [1.47, 4.87]), closed fracture (p = 0.02, OR = 0.86, 95% CI [0.75, 0.98]), high-energy injury (p = 0.003, OR = 0.37, 95% CI [0.19, 0.71]), motorized accident (p = 0.0009, OR = 0.41, 95% CI [0.24, 0.69]), proximal fracture, AO-C-type fracture, comminuted fracture, and Schatzker grade IV-VI fracture were associated with the development of ACS. Additionally, femoral displacement ratio and tibial widening ratio in the ACS groups were significantly higher than in the non-ACS group. CONCLUSION Many factors were found to be associated with the development of ACS following tibial fractures. We provide references when we met the above characteristics of patients to rapidly identify and highly concern ACS.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yubin Long
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Muacevic A, Adler JR, Satone PR, Wadhokar OC, Phansopkar P. Early-Stage Physical Therapy for a Patient With Proximal Tibial Fracture With Acute Compartment Syndrome and Neurovascular Deficits Managed With External Fixation Complicated by Chronic Osteomyelitis: A Case Report. Cureus 2022; 14:e31333. [PMID: 36514572 PMCID: PMC9733803 DOI: 10.7759/cureus.31333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/10/2022] [Indexed: 11/12/2022] Open
Abstract
Tibial fractures occur following low-energy and high-energy trauma resulting from indirect and direct impacts, respectively. High-velocity trauma like road traffic accidents usually results in open fractures of the tibia associated with acute compartment syndrome, posing a serious threat. Thus, this injury requires prompt operative management with fasciotomy followed by fixating the fracture with an external fixator to avoid infection. Despite all the efforts, sometimes this condition may lead to osteomyelitis of the tibia requiring further care. Meanwhile, the patient has to be kept immobilized for a longer duration of time, which allows further complications to occur. Therefore, structured physiotherapeutic management of patients postoperatively is of immense necessity to prevent complications associated with prolonged immobility and achieve an optimal level of functional independence, thereby facilitating the patient to come back to near-normal life as soon as possible. Our case report provides a structured early-stage postoperative physical therapy treatment protocol for a patient with a proximal tibial fracture with acute compartment syndrome and neurovascular deficit managed with Ilizarov fixation.
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Sonawane K, Dhamotharan P, Dixit H, Gurumoorthi P. Coping With the Fear of Compartment Syndrome Without Compromising Analgesia: A Narrative Review. Cureus 2022; 14:e30776. [DOI: 10.7759/cureus.30776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
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21
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Gamulin A, Wuarin L, Zingg M, Belinga P, Cunningham G, Gonzalez AI. Association between open tibia fractures and acute compartment syndrome: A retrospective cohort study. Orthop Traumatol Surg Res 2022; 108:103188. [PMID: 34929394 DOI: 10.1016/j.otsr.2021.103188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies on the association of open tibia fractures and acute compartment syndrome (ACS) show confusing results, with some papers highlighting a positive association, and others failing to do so. The aim of this study was to determine if an open tibia fracture is at increased risk of ACS occurrence, when compared to a closed fracture. HYPOTHESIS Skin injury in the setting of an open tibia fracture does not prevent from ACS occurrence, because the energy transmitted to the limb during trauma may lead to soft tissue lesions, including skin lacerations and ACS. PATIENTS AND METHODS In total, 711 consecutive adult patients (mean age 44.6 years; 65.8% males) sustaining 725 tibia fractures between 01.01.2005 and 31.12.2009 were included in this retrospective study. The outcome measure was ACS. The following variables were assessed: soft tissue condition, age, sex, low- vs. high-energy injury, type of fracture, associated contiguous skeletal injury. A logistic regression model was used and adjustment was performed for age and sex. RESULTS ACS occurred in 10.4% of proximal intra-articular fractures, 10.4% of extra-articular fractures and 3.3% of distal intra-articular fractures, and in 8.7% of closed fractures, 7.8% of open Gustilo 1 fractures and 13.3% of open Gustilo 2 and 3 fractures. Open lesions were not associated with ACS when tibia fractures were considered as a whole. When stratifying by types of fractures, open Gustilo 2 and 3 lesions were associated with ACS in proximal intra-articular fractures (p=0.048). There was no association with closed or any type of open lesions for extra-articular fractures. There were not enough ACS cases among distal intra-articular fractures to draw conclusions. DISCUSSION As ACS may occur with any type of open tibia fractures, clinicians should not be wrongly reassured by an open fracture, assuming that the wound would relieve the pressure inside the muscle compartments. There is a weak association between open Gustilo 2 and 3 lesions and ACS in proximal intra-articular fractures only. These findings are important for surgeons treating these injuries, especially by intubated, sedated or obtunded patients. LEVEL OF EVIDENCE III; retrospective diagnostic study.
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Affiliation(s)
- Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland.
| | - Lydia Wuarin
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Patrick Belinga
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Gregory Cunningham
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
| | - Amanda I Gonzalez
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
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22
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Reply to Letter to the Editor: Preoperative Peripheral Nerve Blocks in Orthopaedic Trauma Surgery: A Guide to Diagnosis-Based Treatment. J Am Acad Orthop Surg 2022; 31:e463-e464. [PMID: 36821397 DOI: 10.5435/jaaos-d-22-00441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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23
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Bister V, Lenkkeri T, Parkkinen M, Lindahl J. Intra-articular distal tibial fractures cause a major burden to individual patients and also stresses the public health care system. Injury 2022; 53:2888-2892. [PMID: 35676161 DOI: 10.1016/j.injury.2022.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Intra-articular distal tibial fractures are most commonly caused by high-energy trauma. Additional difficulties are related to accompanying soft-tissue injuries. The purpose of this study was to evaluate the consequences of different types of distal tibial fractures to the individual patient and to the public health care system. PATIENTS AND METHODS 126 patients with operatively treated intra-articular distal tibial fracture were identified between 2012 and 2016. Thirty-one (25%) were open fractures. Acute treatment, timing of definitive surgery, total number of surgical procedures, complications, need for soft-tissue reconstructions, hospital stay, and number of follow-up visits were recorded related to AO/OTA fracture types. RESULTS 112 patients (89%) were treated with a staged treatment protocol. Of these patients, 74 first received an external fixation device. The definitive fracture fixation was performed on average 8 days after the trauma. Soft-tissue flap reconstruction was needed in 19 patients (15%). Additionally, 7 patients required split-thickness skin grafting. Total hospital stay ranged from 2 to 87 days (median 14 days). The median ward treatment period was 12 days in B2-3 group, 13 days in C1-2 group, and 18 days in C3 group. The median of 2 (range 1-13) surgical procedures were performed. INTERPRETATION Intra-articular distal tibial fractures cause a major burden to individual patients and stresses the public health care system due to a frequent need for several surgical procedures because of soft-tissue injuries and complications. AO/OTA type C3 fractures had the greatest burden, as patients required several consecutive operations and prolonged hospital stays.
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Affiliation(s)
- Ville Bister
- Peijas Hospital, Helsinki University Hospital Trauma Unit, Vantaa, Finland; Department of Surgery, Clinicum, Faculty of medicine, University of Helsinki, Finland.
| | - Timo Lenkkeri
- Töölö Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Markus Parkkinen
- Pihlajalinna Dextra and Laser Tilkka Hospital, Helsinki, Finland
| | - Jan Lindahl
- Department of Surgery, Clinicum, Faculty of medicine, University of Helsinki, Finland; Töölö Hospital, Helsinki University Hospital, Helsinki, Finland
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24
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Schupbach D, Honjol Y, Bouklouch Y, Merle G, Harvey EJ. Acute Compartment Syndrome Modeling with Sequential Infusion Shows the Deep Posterior Compartment Is Not Functionally Discrete. J Bone Joint Surg Am 2022; 104:813-820. [PMID: 35041625 DOI: 10.2106/jbjs.21.00291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical case series have indicated that 1 or 2-compartment decompression of the anterior or lateral leg may be sufficient for release, but, currently, no cadaveric model has verified that approach. The objective of this study was to investigate the functional relationship between compartments by alternating sequences of infusion and fasciotomy release. METHODS This study utilized multicompartment sequential pressurization with simultaneous monitoring by continuous pressure sensors to model compartment syndrome in a human cadaver leg. Subsequent sequential release of compartments and continuous streaming of pressure readings permitted unique insights. RESULTS A leg model allowed the examination of pressure changes in all 4 compartments as treated with sequential fasciotomies. The successful modeling of lower-leg pressures consistent with compartment syndrome showed that discrepancies relative to accepted concepts were seen when the deep posterior compartment was pressurized in isolation. Also, release of 1 of the 2 of either the anterior or lateral compartments seems to be sufficient for decompression to acceptable pressure levels. CONCLUSIONS The deep posterior compartment does not appear to be completely discrete and instead follows the pressurization curve of the posterior muscle group. This indicates that release of the deep posterior compartment may not be needed in all acute compartment syndrome scenarios. CLINICAL RELEVANCE Surgical techniques can be modified for treatment of acute compartment syndrome to avoid large scar lengths, deep dissection, and multiple exposures that could improve patient outcomes.
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Affiliation(s)
- Drew Schupbach
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada.,Experimental Surgery Program, McGill University, Montreal, Quebec, Canada
| | - Yazan Honjol
- Experimental Surgery Program, McGill University, Montreal, Quebec, Canada
| | - Yasser Bouklouch
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Geraldine Merle
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Edward J Harvey
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
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25
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Nilsson A, Ibounig T, Lyth J, Alkner B, von Walden F, Fornander L, Rämö L, Schmidt A, Schilcher J. BioFACTS: biomarkers of rhabdomyolysis in the diagnosis of acute compartment syndrome - protocol for a prospective multinational, multicentre study involving patients with tibial fractures. BMJ Open 2022; 12:e059918. [PMID: 35501102 PMCID: PMC9062790 DOI: 10.1136/bmjopen-2021-059918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The ischaemic pain of acute compartment syndrome (ACS) can be difficult to discriminate from the pain linked to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is based on clinical findings and performed at a low level of suspicion. Biomarkers of muscle cell damage may help to identify and monitor patients at risk, similar to current routines for patients with acute myocardial infarction. This study will test the hypothesis that biomarkers of muscle cell damage can predict ACS in patients with tibial fractures. METHODS AND ANALYSIS Patients aged 15-65 years who have suffered a tibial fracture will be included. Plasma (P)-myoglobin and P-creatine phosphokinase will be analysed at 6-hourly intervals after admission to the hospital (for 48 hours) and-if applicable-after surgical fixation or fasciotomy (for 24 hours). In addition, if ACS is suspected at any other point in time, blood samples will be collected at 6-hourly intervals. An independent expert panel will assess the study data and will classify those patients who had undergone fasciotomy into those with ACS and those without ACS. All primary comparisons will be performed between fracture patients with and without ACS. The area under the receiver operator characteristics curves will be used to identify the success of the biomarkers in discriminating between fracture patients who develop ACS and those who do not. Logistic regression analyses will be used to assess the discriminative abilities of the biomarkers to predict ACS corrected for prespecified covariates. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethical Review Boards in Linköping (2017/514-31) and Helsinki/Uusimaa (HUS/2500/2000). The BioFACTS study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology recommendations. TRIAL REGISTRATION NUMBER NCT04674592.
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Affiliation(s)
- Abraham Nilsson
- Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Faculty of Health Science, Linköping University Hospital, Linkoping, Sweden
| | - Thomas Ibounig
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, and, University of Helsinki, Helsinki, Finland
| | - Johan Lyth
- Department of Health Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Björn Alkner
- Department of Orthopaedics, Eksjö, Region Jönköping County and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ferdinand von Walden
- Division of Pediatric Neurology, Department of Women's and Children's health, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Fornander
- Department of Orthopaedics, Norrköping, Östergötland County and Department of Biomedical and Clinical Sciences in Norrköping, Linköping University, Linköping, Sweden
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, and, University of Helsinki, Helsinki, Finland
| | - Andrew Schmidt
- Department of Orthopaedics, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Jörg Schilcher
- Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Faculty of Health Science, Linköping University Hospital, Linkoping, Sweden
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Sonawane K, Shah A, Balavenkatasubramanian J. Resolving the Conflict Between Regional Analgesia and Developing Compartment Syndrome in Below-Knee Surgeries With the High-Volume Proximal Adductor Canal (Hi-PAC) Block: A Prospective Feasibility Study. Cureus 2022; 14:e23898. [PMID: 35530866 PMCID: PMC9076042 DOI: 10.7759/cureus.23898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
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27
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Torrie AM, Brookman JC, Samet RE. Regional Analgesia and Acute Compartment Syndrome. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Smolle MA, Petermeier V, Ornig M, Leitner L, Eibinger N, Puchwein P, Leithner A, Seibert FJ. A nomogram predicting risk for acute compartment syndrome following tibial plateau fractures. Single centre retrospective study. Injury 2022; 53:669-675. [PMID: 34742572 DOI: 10.1016/j.injury.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
Background This study aimed at analysing risk factors for development of acute compartment syndrome (ACS) in tibial plateau fractures, and to construct a nomogram predicting ACS-risk. Patients and Methods 243 patients (102 males; mean age: 50.7 [range: 18-85] years) with 253 tibial plateau fractures treated between 2010 and 2019 at a level-1 trauma centre were retrospectively included. Uni- and multivariate logistic regression analysis with odds ratios (OR) were performed to assess variables predicting ACS. Based on the multivariate model, ROC curve, Youden index, and nomogram were constructed. Results ACS developed in 23 patients (9.1%), with risk factors being male gender (OR: 10.606; p<0.001), BMI (OR: 1.084; p = 0.048), polytrauma (OR: 4.085; p = 0.003), and Schatzker type IV-VI fractures (OR: 6.325; p = 0.004). Age, ASA score, diabetes, renal insufficiency, hypertension, smoking or open fracture were not significantly associated with ACS-risk (all p>0.05). In the multivariate analysis, male gender (OR: 7.392; p = 0.002), and Schatzker type IV-VI fractures (OR: 5.533; p = 0.009) remained independent negative ACS-predictors, irrespective of polytrauma (p = 0.081), or BMI (p = 0.194). Area under the ROC curve was 0.840. Youden index revealed a cut-off value of ≥ 18%, upon which patients are at extremely high risk for ACS. Conclusions Particular attention should be paid to male patients with high-energy fractures of the tibial plateau towards any signs of ACS of the affected extremity to initiate early treatment. The compiled nomogram, consisting of four easily quantifiable clinical variables, may be used in clinical practice to individually predict ACS risk. Any risk score ≥ 18% should prompt critical monitoring towards ACS, or even prophylactic fasciotomy during primary surgery.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Verena Petermeier
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Martin Ornig
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Nicolas Eibinger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Paul Puchwein
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Franz-Josef Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Patel AH, Wilder JH, Lee OC, Ross AJ, Vemulapalli KC, Gladden PB, Martin MP, Sherman WF. A Review of Proximal Tibia Entry Points for Intramedullary Nailing and Validation of The Lateral Parapatellar Approach as Extra-articular. Orthop Rev (Pavia) 2022; 14:31909. [PMID: 35106131 PMCID: PMC8801390 DOI: 10.52965/001c.31909] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Tibial shaft fractures are the most common long bone injury and are often treated surgically in an attempt to minimize complications. Although treatment options for tibial shaft fractures vary based on factors including open injury, severity of fracture, and soft tissue status, intramedullary nailing in adults has emerged as the preferred definitive option for stabilization. Therefore, the primary purposes of this review and cadaveric study were to evaluate the entry points for reamed tibial nails and the risks, benefits, and advantages of each approach. Due to concerns of violating the joint capsule and the generalized applicability to everyday practice of the extra-articular lateral parapatellar semi-extended technique, the secondary goal of this manuscript was to evaluate whether an intramedullary tibial nail can be consistently placed extra-articularly using the lateral parapatellar technique described by Kubiak et al. and generalizability to surgeons of varying experience.
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Affiliation(s)
- Akshar H Patel
- Orthopaedic Surgery, Tulane University School of Medicine
| | - J Heath Wilder
- Orthopaedic Surgery, Tulane University School of Medicine
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Tulane University School of Medicine; Department of Orthopaedic Surgery, Louisiana State University School of Medicine and Southeast Louisiana Veterans Health Care System
| | - Austin J Ross
- Orthopaedic Surgery, Tulane University School of Medicine
| | | | - Paul B Gladden
- Orthopaedic Surgery, Tulane University School of Medicine
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Leroux A, Frey KP, Crainiceanu CM, Obremskey WT, Stinner DJ, Bosse MJ, Karunakar MA, O'Toole RV, Carroll EA, Hak DJ, Hayda R, Alkhoury D, Schmidt AH. Defining Incidence of Acute Compartment Syndrome in the Research Setting: A Proposed Method From the PACS Study. J Orthop Trauma 2022; 36:S26-S32. [PMID: 34924516 DOI: 10.1097/bot.0000000000002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the retrospective decision of an expert panel who assessed likelihood of acute compartment syndrome (ACS) in a patient with a high-risk tibia fracture with decision to perform fasciotomy. DESIGN Prospective observational study. SETTING Seven Level 1 trauma centers. PATIENTS/PARTICIPANTS One hundred eighty-two adults with severe tibia fractures. MAIN OUTCOME MEASUREMENTS Diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver-operator curve) of an expert panel's assessment of likelihood ACS compared with fasciotomy as the reference diagnostic standard. SECONDARY OUTCOMES The interrater reliability of the expert panel as measured by the Krippendorff alpha. Expert panel consensus was determined using the percent of panelists in the majority group of low (expert panel likelihood of ≤0.3), uncertain (0.3-0.7), or high (>0.7) likelihood of ACS. RESULTS Comparing fasciotomy (the diagnostic standard) and the expert panel's assessment as the diagnostic classification (test), the expert panel's determination of uncertain or high likelihood of ACS (threshold >0.3) had a sensitivity of 0.90 (0.70, 0.99), specificity of 0.95 (0.90, 0.98), PPV of 0.70 (0.50, 0.86), and NPV of 0.99 (0.95, 1.00). When a threshold of >0.7 was set as a positive diagnosis, the expert panel assessment had a sensitivity of 0.67 (0.43, 0.85), specificity of 0.98 (0.95, 1.00), PPV of 0.82 (0.57, 0.96), and NPV of 0.96 (0.91, 0.98). CONCLUSION In our study, the retrospective assessment of an expert panel of the likelihood of ACS has good specificity and excellent NPV for fasciotomy, but only low-to-moderate sensitivity and PPV. The discordance between the expert panel-assessed likelihood of ACS and the decision to perform fasciotomy suggests that concern regarding potential diagnostic bias in studies of ACS is warranted. LEVEL OF EVIDENCE Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew Leroux
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Katherine P Frey
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ciprian M Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel J Stinner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Bosse
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Madhav A Karunakar
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD
| | - Eben A Carroll
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, NC
| | - David J Hak
- Department of Orthopedics, Denver Health and Hospital Authority, Denver, CO (now at Department of Orthopedic Trauma, Hughston Clinic, Sanford, FL)
| | - Roman Hayda
- Department of Orthopaedic Surgery, Rhode Island Hospital at Brown University, Providence, RI; and
| | - Dana Alkhoury
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew H Schmidt
- Department of Orthopedic Surgery, Hennepin Healthcare, Minneapolis, MN
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Abstract
High-energy tibial plateau fractures carry a high risk of associated acute compartment syndrome. Clinicians should be familiar with several demographic, clinical, and radiographic factors that are associated with compartment syndrome development after tibial plateau fracture. Once the diagnosis of compartment syndrome is made, emergent decompressive fasciotomies are needed. Fracture fixation complicates the treatment course and elements of postoperative management. Deep surgical site infection is a common complication, and controversy remains regarding the ideal timing of fixation and soft tissue closure for these complex injuries.
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Affiliation(s)
- Brian A Schneiderman
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
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32
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Deng X, Hu H, Ye Z, Zhu J, Zhang Y, Zhang Y. Predictors of acute compartment syndrome of the lower leg in adults following tibial plateau fractures. J Orthop Surg Res 2021; 16:502. [PMID: 34399816 PMCID: PMC8365966 DOI: 10.1186/s13018-021-02660-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute 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 METHODS From 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. RESULTS Of 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. CONCLUSION Younger 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.
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Affiliation(s)
- Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery of Hebei Province, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hongzhi Hu
- Department of Orthopedics, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430022, Wuhan, People's Republic of China
| | - Zhipeng Ye
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China
| | - Jian Zhu
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China
| | - Yiran Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China
| | - Yingze Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China. .,Department of Orthopaedic Surgery of Hebei Province, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Suomalainen P, Pakarinen TK, Pajamäki I, Laitinen MK, Laine HJ, Repo JP, Mattila VM. Does the shoe-lace technique aid direct closure of fasciotomy wounds after acute compartment syndrome of the lower leg? a retrospective case-control study. Scand J Surg 2021; 110:492-497. [PMID: 34078192 PMCID: PMC8688972 DOI: 10.1177/14574969211019639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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.
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Affiliation(s)
- P Suomalainen
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - T-K Pakarinen
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - I Pajamäki
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - M K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H-J Laine
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - J P Repo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - V M Mattila
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland.,The School of Medicine, Tampere University, Tampere, Finland
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Modern Principles in the Acute Surgical Management of Open Distal Tibial Fractures. J Am Acad Orthop Surg 2021; 29:e536-e547. [PMID: 33788807 DOI: 10.5435/jaaos-d-20-00502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/08/2021] [Indexed: 02/01/2023] Open
Abstract
Over the past two decades, management of open distal tibial fractures has evolved such that a staged approach, with external fixation and débridement during the index procedure, followed by definitive fixation and wound closure at a later date, is often considered the standard of care. Although definitive treatment of these complex injuries is often done by a multidisciplinary team of surgeons well versed in periarticular fracture repair and soft-tissue coverage in the distal extremity, the on-call orthopaedic surgeon doing the index procedure must understand the principles and rationale of the staged treatment algorithm to avoid compromising definitive treatment options and ensure the best possible patient outcome. The mechanism of injury, neurovascular status, size and location of soft-tissue injury, fracture pattern, and concomitant injuries in the polytraumatized patient should direct the treatment plan and anticipated outcomes. This review focuses on evaluation and management of these complex injuries with an emphasis on early aggressive débridement, principles of initial fracture fixation, and modern options for soft-tissue coverage, including local and free tissue transfer.
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Aya K, Johnson CS, Emili U, Jupiter DC, Lindsey RW. Identifying risk factors for missed compartment syndrome in patients with tibia shaft fractures: An analysis of the national trauma data bank. Injury 2021; 52:1621-1624. [PMID: 33487405 DOI: 10.1016/j.injury.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 01/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Acute compartment syndrome (CS) is a common complication of tibia shaft fractures (TSFs), and occurs when the pressure inside a myofascial compartment rises and impairs tissue perfusion. If treatment is delayed due to a missed diagnosis, amputation or permanent loss of function can result. This study aims to determine the incidence, clinical associations, and risk factors for missed CS following surgical stabilization of tibia shaft fractures (TSFs) using data from the National Trauma Data Bank (NTDB). METHODS NTDB data files from 2007 to 2016 were accessed to collect information on patients undergoing surgical fixation of TSFs. Patients with an Injury Severity Score (ISS) > 15 or inferred Gustilo-Anderson IIIB/IIIC fractures were excluded to create a more homogenous sample of lower-grade TSFs. Compartment syndrome that was originally missed leading to late intervention was the main outcome under investigation. Bivariate tests were used to assess the relationships between missed CS and the preoperative variables. If a variable and a complication had an association with a P ≤ 0.2, it was included in a multivariate logistic regression model. RESULTS A total of 184,612 patients met our inclusion criteria, and 1,269 patients (0.76%) had a missed CS diagnosis. Bivariate analysis demonstrated that male gender had a significant positive association with a missed CS diagnosis, while older age had a significant negative association (odds ratio [OR] = 2.17, 0.99; P < 0.001). Multivariate analysis revealed that male gender was the most significant independent risk factor for a missed diagnosis of compartment syndrome (OR = 1.84, P < 0.00001), followed by alcoholism, penetrating trauma, and smoking (OR = 1.51, 1.46, 1.43; P < 0.02). The only significant protective factor was open fracture (OR = 0.70, P < 0.0001). CONCLUSIONS Our research identified several significant risk factors for missed CS after TSF, as well as positive and negative associations. Male gender, age, and lifestyle choices such as alcohol use and smoking conferred increased risks. These variables may assist physicians in identifying at-risk patients who may benefit from increased monitoring, and potentially prevent the high morbidity associated with this condition.
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Affiliation(s)
- Kessiena Aya
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd, Route 0165, Galveston, TX 77555, United States.
| | - Connor S Johnson
- School of Medicine, The University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555, United States
| | - Uchechukwu Emili
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN 46202, United States
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd, Route 0165, Galveston, TX 77555, United States; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Ewing Hall, Suite 1.134 G, 700 Harborside Dr, Galveston, TX 77555, United States
| | - Ronald W Lindsey
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd, Route 0165, Galveston, TX 77555, United States
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Jyala A, Shah N, Ali N. An Unusual Case of Compartment Syndrome of the Upper Extremity Caused by an iPad. Cureus 2021; 13:e14457. [PMID: 33996317 PMCID: PMC8117944 DOI: 10.7759/cureus.14457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute compartment syndrome develops when intracompartmental pressure increases either due to intrinsic or extrinsic causes. Increase in compartment pressure eventually can lead to impaired tissue perfusion followed by tissue death if no urgent intervention is performed. Patients with acute compartment syndrome usually present with pain out of proportion to apparent injury. It can cause rhabdomyolysis, myoglobinuria, and eventually acute renal failure. The definite treatment is fasciotomy in a timely manner. We here report a very interesting case of acute compartment syndrome in a young patient cause by pressure over his axilla by an iPad.
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Affiliation(s)
| | - Niel Shah
- Internal Medicine, BronxCare Health System, Bronx, USA
| | - Nisha Ali
- Internal Medicine, BronxCare Health System, Bronx, USA
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Civilian Ballistic Tibia Shaft Fractures Compared With Blunt Tibia Shaft Fractures: Open or Closed? J Orthop Trauma 2021; 35:143-148. [PMID: 33079843 DOI: 10.1097/bot.0000000000001911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify a group of ballistic tibia fractures, report the outcomes of these fractures, and compare them with both closed and open tibia fractures sustained by blunt mechanisms. We hypothesized that ballistic tibia fractures and blunt open fractures would have similar outcomes. DESIGN Retrospective cohort study. SETTING A single Level-1 trauma center. PATIENTS/PARTICIPANTS Adult patients presenting with ballistic (44), blunt closed (179), or blunt open (179) tibia fractures. INTERVENTION Intramedullary stabilization of tibia fracture. MAIN OUTCOMES Unplanned reoperation, soft tissue reconstruction, nonunion, compartment syndrome, and fracture-related infection. RESULTS Compared with the blunt closed group, the ballistic fracture group required more operations (P < 0.01), had a higher occurrence of soft tissue reconstruction (P < 0.01), and higher incidence of compartment syndrome (P = 0.02). Ballistic and blunt closed groups did not significantly differ in rates of unplanned reoperation (P = 0.67), nonunion (11.4% vs. 4.5%, P = 0.08), or deep infection (9.1% vs. 5.6%, P = 0.49). In comparison to the blunt open group, the ballistic group required a similar number of operations (P = 0.12), had similar rates of unplanned reoperation (P = 0.10), soft tissue reconstruction (P = 0.56), nonunion (11.4% vs. 17.9%, P = 0.49), and fracture-related infection (9.1% vs. 10.1%, P = 1.0) but a higher incidence of compartment syndrome (15.9% vs. 5.0%, P = 0.02). CONCLUSIONS Ballistic tibia fractures require more surgeries and have higher rates of soft tissue reconstruction than blunt closed fractures and seem to have outcomes similar to lower severity open fractures. We found a significantly higher rate of compartment syndrome in ballistic tibia fractures than both open and closed blunt fractures. When treating ballistic tibia fractures, surgeons should maintain a high level of suspicion for the development of compartment syndrome and counsel patients that ballistic tibia fractures seem to behave like an intermediate category between closed and open fractures sustained through blunt mechanisms. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Schultz K, Kräbber M, Lazovic D, Maus U. Acute Compartment Syndrome of the Lower Leg Using Navigated Endoprosthesis of the Knee. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 160:222-225. [PMID: 33336330 DOI: 10.1055/a-1295-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute compartment syndrome of the lower leg following computer navigated primary total knee arthroplasty is rare but potentially devastating. This could be triggered by a setting of the bicortical tibial navigation pin. It is essential to take care during the operation, and to implement close post-operative control, especially if there are risk factors or nerve blocks.
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Affiliation(s)
- Katharina Schultz
- Department of Orthopaedics & Trauma Surgery, University Hospital Düsseldorf, Germany
| | - Manuel Kräbber
- Department of Orthopaedics & Trauma Surgery, Pius-Hospital Oldenburg, Germany
| | - Djordje Lazovic
- Department of Orthopaedics & Trauma Surgery, Pius-Hospital Oldenburg, Germany
| | - Uwe Maus
- Department of Orthopaedics & Trauma Surgery, University Hospital Düsseldorf, Germany
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Saiz AM, Wellman AC, Stwalley D, Wolinsky P, Miller AN. The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank. J Orthop Trauma 2020; 34:e154-e158. [PMID: 31738240 PMCID: PMC7991978 DOI: 10.1097/bot.0000000000001702] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture. METHODS Data from the National Trauma Data Bank for the years 2004-2016 were analyzed, and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy. RESULTS A total of 1.22% of the forearm fractures and 3.79% of the tibial fractures had a fasciotomy. Patients with a fasciotomy were more likely to have invasive procedures (P < 0.0001); have injuries resulting from machinery, motor vehicle collisions, and firearms (P < 0.0001); and smoke, use drugs, and/or alcohol (P < 0.05) compared with patients who did not undergo fasciotomies. Fasciotomy procedures were associated with longer LOS and higher mortality rate (P < 0.05). CONCLUSIONS The incidence of a fasciotomy is less than 5% in tibia or forearm fractures. Patients who underwent fasciotomy have higher energy injuries, increased alcohol or drug use, higher rates of surgical interventions, and increased LOS. Furthermore, having a fasciotomy is associated with increased mortality rate. When counseling patients and evaluating surgeon/hospital performance, fasciotomies can serve as an indicator and modifier for a more complex trauma pathology. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Augustine M. Saiz
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | | | - Dustin Stwalley
- Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Philip Wolinsky
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Anna N. Miller
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
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Compartment Syndrome in Tibial Plateau Fractures: Do Previously Established Predictors Have External Validity? J Orthop Trauma 2020; 34:238-243. [PMID: 31738237 DOI: 10.1097/bot.0000000000001703] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test previously established radiographic predictors of compartment syndrome in tibial plateau fractures and determine whether novel measurements may further improve a surgeon's ability to identity patients at high risk for developing this outcome. DESIGN Retrospective review. SETTING Academic Level I trauma center. PATIENTS Five hundred thirteen patients with tibial plateau fractures treated operatively over a 10-year period (OTA/AO 41B1-3 & 41C1-3; Schatzker I-VI). INTERVENTION Previously established plain film radiographic measurements and novel computed tomography soft tissue measurements. MAIN OUTCOME MEASURE Acute compartment syndrome (ACS). RESULTS Schatzker VI fractures (odds ratio 5.72, confidence interval 2.55-12.83, P < 0.001), high-energy mechanism (3.10, 1.26-7.58, P = 0.0096), fibular fracture (8.14, 3.33-19.96, P < 0.0001), fracture length (9.70, 2.45-37.69, P = 0.0014), and plateau-shaft combined injury (2.97, 1.15-7.70, P = 0.019) were all associated with the development of compartment syndrome. The depth of the posterior compartment was also predictive of CS (1.06, 1.02-1.09, P = 0.0025). Patients with 3 and 4 predictive markers demonstrated a 20% and 27% chance of developing ACS respectively. CONCLUSIONS This study confirms that several factors are associated with the development of ACS. The presence of each independent predictor had a cumulative effect such that when more than one variable is present, the chance of ACS increases. This information may be used to alert providers regarding injuries that require vigilant evaluation. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Martin LKD, Mcbride LTJ, Unangst CA, Chisholm J. Prospective Study of Military Special Operations Medical Personnel and Lower Extremity Fracture Immobilization in an Austere Environment. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420916144. [PMID: 35097374 PMCID: PMC8697082 DOI: 10.1177/2473011420916144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Austere fracture immobilization equipment and techniques are often overlooked, with few studies critically evaluating the process. The purpose of this study was to evaluate current austere splinting techniques and equipment used for lower extremity fractures while field testing a new 1-step spray-on foam splint. Methods: This is a prospective analysis of austere splinting techniques. A cadaveric model with a distal third tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (structural aluminum malleable [SAM] splint, 6-in. ACE wrap) while being critically evaluated. The specimens were also immobilized with a 1-step in-situ foam splint. Results: Twenty-one military Special Operations medical personnel participated. Each participant was observed and scored by a single orthopedic foot and ankle surgeon using a Likert scale based on 10 splinting criteria. Standard splinting resulted in an average score of 32.2 (range, 5-50), with significant deficiencies in fracture traction (1/5), fracture motion (2.9/5), protection of neurovascular structures (3/5), and soft tissue manipulation (3/5). The average time to completion was 203 seconds, with 1 splint failure. The spray-on foam splinting technique yielded a significantly higher score of 48.5 while completing the task significantly faster (68 seconds), with no failures. Conclusion: Special Operations medical personnel demonstrated success in immobilizing a complex fracture with standard techniques in a cadaveric model. However, testing demonstrated the inherent inability of the SAM splint to provide longitudinal traction while simultaneously allowing excessive fracture motion and potential injury to the soft tissues. In comparison, our spray-on foam proof of concept technique eliminated motion by allowing an in situ application with adequate rigidity. Clinical Relevance: This experiment included a likert scale to critically evaluate splinting techniques and equipment. It reliably tested standard splinting equipment and a 1-step in-situ foam splint for distal third tibia-fibula fractures.
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Do Patient-specific or Fracture-specific Factors Predict the Development of Acute Compartment Syndrome After Pediatric Tibial Shaft Fractures? J Pediatr Orthop 2020; 40:e193-e197. [PMID: 31157755 DOI: 10.1097/bpo.0000000000001410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tibial shaft fractures are the most common injuries preceding acute compartment syndrome (ACS), so it is important to understand the incidence of and risk factors for ACS after pediatric tibial shaft fractures. The purposes of this study were to determine the rate at which ACS occurs and if any patient or fracture characteristics are significantly associated with developing ACS. METHODS All patients aged 5 to 17 years treated for a tibial shaft fracture at a level 1 pediatric trauma center, a level 1 adult trauma center, and an outpatient orthopaedic practice between 2008 and 2016 were retrospectively identified. Demographics, mechanisms of injury, and fracture characteristics were collected from the medical records. Radiographs were reviewed by study authors. ACS was diagnosed clinically or by intracompartmental pressure measurement. Univariable analysis was performed using the Fisher exact test for nominal variables and simple logistic regression for continuous variables. Multivariable analysis was performed using stepwise logistic regression. RESULTS Among 515 patients with 517 tibial shaft fractures, 9 patients (1.7%) with 10 (1.9%) fractures developed ACS at a mean age of 15.2 years compared with a mean age of 11 years in patients without ACS (P=0.001). One patient with bilateral tibial fractures developed ACS bilaterally. Age greater than 14 years (P=0.006), higher body mass index (P<0.001), motorcycle or motor vehicle accidents (P=0.034), comminuted and segmental tibial shaft fractures (P<0.001), ipsilateral fibular fracture (P=0.002), and associated orthopaedic injuries (P=0.032) were all significantly more common in the ACS group. CONCLUSIONS ACS developed in 1.7% of the patients with tibial shaft fractures in this retrospective study-a rate significantly lower than previously reported. Age greater than 14 years, higher body mass index, motor vehicle or motorcycle accidents, comminuted or segmental fracture pattern, ipsilateral fibular fracture, and associated orthopaedic injuries are all significantly associated with its development. LEVELS OF EVIDENCE Level III-retrospective comparative study.
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Wuarin L, Gonzalez AI, Zingg M, Belinga P, Hoffmeyer P, Peter R, Lübbeke A, Gamulin A. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial shaft fractures: a retrospective cohort study. BMC Musculoskelet Disord 2020; 21:25. [PMID: 31931775 PMCID: PMC6958679 DOI: 10.1186/s12891-020-3044-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/06/2020] [Indexed: 01/18/2023] Open
Abstract
Background The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome. Methods 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high- vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and over-riding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p < 0.05. Results Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm. Conclusions One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.
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Affiliation(s)
- Lydia Wuarin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Amanda I Gonzalez
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Matthieu Zingg
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Patrick Belinga
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Pierre Hoffmeyer
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Robin Peter
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Anne Lübbeke
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland.
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Selective fasciotomy for acute traumatic lower leg compartment syndrome: is it feasible? Arch Orthop Trauma Surg 2019; 139:1755-1762. [PMID: 31428851 DOI: 10.1007/s00402-019-03260-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The standard treatment for an acute compartment syndrome (ACS) of the lower leg is a four compartment fasciotomy. It can be performed through either one lateral or a lateral and medial incision. Selective fasciotomy, only opening the compartments with elevated pressure, is a less invasive procedure. The aim of this study was to describe a procedure of selective fasciotomy after pressure measurement and to determine its feasibility in a retrospective cohort study. METHODS All patients with an ACS of the lower leg due to a proximal or tibia shaft fracture (AO 41 or 42) who received either a four compartment fasciotomy or a selective fasciotomy after pressure measurement between 2006 and 2016 were included. Every compartment with an intracompartment pressure of more than 30 mmHg was opened. The primary outcome was any missed compartment syndrome after selective fasciotomy. Secondary outcomes were reoperations for completing four compartment fasciotomy and persistent sensomotoric deficits. RESULTS Fifty-one patients with a mean age of 43 years (6-76) were included. Of these, 41 (80%) had a selective fasciotomy. There was no missed compartment syndrome. One patient had a reoperation 8 h after primary selective fasciotomy due to ACS of the superficial and deep flexor compartment. The anterior compartment had to be released in all patients. In 67%, the release of 2 compartments was sufficient. Six patients had postoperative sensomotoric deficits at discharge with full recovery during follow-up. CONCLUSION Selective fasciotomy is feasible and seems to be safe. Future comparative studies will have to focus on possible benefits of this less invasive treatment.
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Stella M, Santolini E, Sanguineti F, Felli L, Vicenti G, Bizzoca D, Santolini F. Aetiology of trauma-related acute compartment syndrome of the leg: A systematic review. Injury 2019; 50 Suppl 2:S57-S64. [PMID: 30772051 DOI: 10.1016/j.injury.2019.01.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acute compartment syndrome (ACS) is characterised by abnormal pressure inside a compartment, resulting in ischemia of muscles and nerves. Most orthopaedic surgeons, especially those who work in major trauma centres, have been or will be facing a case of ACS in their clinical activity. Fortunately, complications related to untreated compartment syndrome have become less frequent thanks to a better understanding of pathogenesis and to early recognition and prompt surgical treatment. The aim of this study is to identify the existing evidence regarding aetiology of trauma-related ACS of the leg. METHODS A systematic review of the literature was undertaken using PubMed Medline, Ovid Medline and the Cochrane library, extended by a manual search of bibliographies. Retrieved articles were eligible for inclusion if they reported data about aetiology of trauma-related compartment syndrome of the tibia. RESULTS Ninety-five studies that fulfilled the inclusion criteria were identified. By dividing the studies into three groups according to the traumatic aetiology, we were able to classify traumatic ACS as fracture related, soft tissue injury related and vascular injury related. Fracture related was the most represented group, comprising 58 papers, followed by the soft tissue injury related group which includes 44 articles and vascular injury related group with 24 papers. CONCLUSIONS Although traditionally ACS has been associated mainly with fractures of tibial diaphysis, literature demonstrates that other localisations, in particular in the proximal tibia, are associated with an increased incidence of this serious condition. The forms of ACS secondary to soft tissues injuries represent an extremely variable spectrum of lesions with an insidious tendency for late diagnosis and consequently negative outcomes. In the case of vascular injury, ACS should always be carefully considered as a priority, given the high incidence reported in the literature, as a result of primitive vascular damage or as a result of revascularisation of the limb. Knowledge of aetiology of this serious condition allows us to stratify the risk by identifying a population of patients most at risk, together with the most frequently associated traumatic injuries.
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Affiliation(s)
- Marco Stella
- Orthopaedics and Trauma Unit, Ente Ospedaliero Ospedali Galliera, Mura delle Cappuccine 14, 16148, Genoa, Italy
| | - Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Francesca Sanguineti
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Lamberto Felli
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Giovanni Vicenti
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Davide Bizzoca
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Federico Santolini
- Orthopaedics and Trauma Unit, Emergency Department, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy
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Du W, Hu X, Shen Y, Teng X. Surgical management of acute compartment syndrome and sequential complications. BMC Musculoskelet Disord 2019; 20:98. [PMID: 30832634 PMCID: PMC6399970 DOI: 10.1186/s12891-019-2476-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Acute compartment syndrome occurs when pressure within a compartment increases and affects the function of the muscle and tissues after an injury. Compartment syndrome is most common in lower leg and may lead to permanent injury to the muscle and nerves if left untreated. Methods 46 patients with acute compartment syndrome were enrolled, including 8 cases with serious complications, between January 2008 and December 2012. The protocols combining early management and the correction of deformities were adjusted in order to attempt to enable full recovery of all patients. Results All patients had necrotic muscles and nerves, damaged vascular, and severe foot deformities. In the early stage, each patient received systemic support and wound debridement to promote wound healing. For patients with serious complications, a number of medical measures, including installation of Ilizarov external frames, arthrodesis, osteotomy fusion, arthroplasty, or tendon lengthening surgery, were performed to achieve satisfactory clinical outcomes. All the patients resumed weight-bearing walking and daily exercises. Conclusion Acute compartment syndrome and sequential complications could be managed using a number of medical procedures.
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Affiliation(s)
- Weili Du
- Department of Burns, Beijing Jishuitan Hospital, 31 Xinjiekou East Rd, Beijing, 100035, China.
| | - Xiaohua Hu
- Department of Burns, Beijing Jishuitan Hospital, 31 Xinjiekou East Rd, Beijing, 100035, China
| | - Yuming Shen
- Department of Burns, Beijing Jishuitan Hospital, 31 Xinjiekou East Rd, Beijing, 100035, China
| | - Xing Teng
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035, China
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Ull C, Jansen O, Seybold D, Königshausen M, Schildhauer TA, Gessmann J. Differences between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome. Eur J Trauma Emerg Surg 2019; 46:1167-1173. [PMID: 30747274 DOI: 10.1007/s00068-019-01089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To analyze the differences in outcomes between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome (ACS). METHODS From our trauma database, we identified a total of 107 patients with 126 fractures of AO/OTA type 41-44 and 120 ACS from January 01, 2001 to December 31, 2015 who were treated with primary or secondary definitive osteosynthesis after concomitant fasciotomy. RESULTS Seventy-one patients with 77 fractures of AO/OTA classification type 41-44 suffering ACS received primary definitive osteosynthesis at the time of compartmental incision (POCI) and were compared to 36 patients with 49 fractures of AO/OTA type 41-44 and ACS, who received secondary definitive osteosynthesis after compartmental incision and soft tissue coverage (SOCI). Patients with POCI had a significantly shorter length of hospital stay with significantly fewer necessary surgeries to achieve definitive fracture treatment and soft tissue closure than SOCI patients (p ≤ 0.001). The overall rate of infections in both groups was 13%, without any difference between POCI and SOCI. CONCLUSIONS POCI for AO/OTA fractures type 41-44 with ACS is a safe and effective procedure without increasing the infection rate compared to a gradual treatment (SOCI). However, the possible selection bias due to the retrospective study design needs to be considered.
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Affiliation(s)
- Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Jan Gessmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
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Gordon WT, Talbot M, Shero JC, Osier CJ, Johnson AE, Balsamo LH, Stockinger ZT. Acute Extremity Compartment Syndrome and the Role of Fasciotomy in Extremity War Wounds. Mil Med 2018; 183:108-111. [DOI: 10.1093/milmed/usy084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wade T Gordon
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Max Talbot
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - John C Shero
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Charles J Osier
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Anthony E Johnson
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Luke H Balsamo
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Zsolt T Stockinger
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
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Abstract
Regional anesthesia for the acute trauma patient is increasing due to the growing appreciation of its benefits, development of newer techniques and equipment, and more robust training. Block procedures are expanding beyond perioperative interventions performed exclusively by anesthesiologists to paramedics on scene, emergency medicine physicians, and nurse-led services using these techniques early in trauma pain management. Special considerations and indications apply to trauma victims compared with the elective patient and must be appreciated to optimize safety and clinical outcomes. This review discusses current literature and future directions in the growing role of regional anesthesia in acute trauma care.
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Affiliation(s)
- Ian R Slade
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359724, Seattle, WA 98104, USA.
| | - Ron E Samet
- Department of Anesthesiology, Division of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
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