Patients who were treated with non-surgical fixation methods or primary amputation, or patients who had open fractures requiring vascular repair or intra-articular fractures, were excluded. Patients developing ACS in this group were identified and relevant information on demographics and risk factors were collected.ĪCS of the lower leg was defined for the purpose of this study as being an acute event following a tibial diaphyseal fracture diagnosed by clinical signs and symptoms and, where necessary, by intra-compartmental pressure measurements, using a handheld intra-compartmental pressure monitoring system (Stryker Surgical, Kalamazoo, MI), but confirmed at fasciotomy and entered prospectively into the data base as ‘Acute Compartment Syndrome’. All tibial diaphyseal fractures that were treated between January 1997 and December 2011 were retrieved from the orthopaedic trauma prospective data base. This retrospective cohort study was conducted at a level-one trauma centre attended by five full-time orthopaedic trauma surgeons. A thorough understanding of these risk factors and their relative influence on development of lower leg ACS may provide better insight into the recognition of high risk individuals, which is critical in an effort to optimize patient outcomes.
The purpose of this study, therefore, was to examine the relationship between the development of ACS in the cohort of patients presenting to our hospital with tibial diaphyseal fractures and specific demographic, injury, and operative characteristics that could predict this occurrence. It is therefore difficult to appreciate the burden of this problem. There has been no large-scale study on the epidemiology of lower leg compartment syndrome so far. However, due to the low incidence of this condition, a high index of suspicion is usually required to initiate one’s thought processes towards making a diagnosis of ACS. Physicians treating patients with traumatic injuries are normally aware of ACS. The cost of ACS is significant, resulting in prolonged hospital stays and charges that are more than doubled in patients with tibial fractures affected by ACS. In addition to the psychological stress for health care givers associated with poor patient outcome, the average indemnity paid for missed ACS is high and the rate of successful defence of cases is lower than with other orthopaedic medico legal cases.
Delayed or missed diagnosis of ACS following tibial shaft fracture negatively affects the health care team as well. have shown that patients who sustained a tibial fracture followed by an ACS, performed worse on the EuroQol score than those who had uncomplicated fractures. Acute compartment syndrome (ACS) is considered to be one of the most serious complications of tibial fractures, and failure to diagnose and treat it in time can lead to catastrophic consequences that are devastating to patients, surgeons and health care providers. Level of evidenceįracture of the tibia is the most common long-bone fracture worldwide. Male gender, open fracture and IM nailing were not risk factors for ACS of the leg associated with tibial diaphyseal fractures in adults. We found that younger patients are definitely at a significantly higher risk of ACS following acute tibial diaphyseal fractures. Increasing pain was the most common symptom in 71 % of cases with ACS. No significant difference in incidence of ACS was found in open versus closed fractures, between anatomic sites and following IM nailing ( P = 0.67). The mean age of those patients that developed ACS (33.08 ± 12.8) was significantly lower than those who did not develop it (42.01 ± 17.3, P < 0.001). ACS of the leg occurred in 87 (7.73 %) of all tibial diaphyseal fractures.
Age, gender, year and mechanism of injury, injury severity score (ISS), fracture characteristics and classifications and the type of fixation, as well as ACS characteristics in affected patients were studied. Among them some were complicated by ACS of the leg. All patients were treated with surgical fixation. Materials and methodsĪ total of 1,125 patients with tibial diaphyseal fractures that were treated in our centre were included into this retrospective cohort study. We sought to examine the occurrence of acute compartment syndrome (ACS) in the cohort of patients with tibial diaphyseal fractures and to detect associated risk factors that could predict this occurrence.
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