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Age among risk factors for compartment syndrome after tibial shaft fracture
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The incidence of compartment syndrome after tibial shaft fractures is much higher than previously reported, according to the results of a recently presented retrospective study.
“This is the first study that investigates the incidence of compartment syndrome in closed tibial shaft fractures,” Benjamin J. Shore, MD, FRCSC, an orthopedic surgeon at Children’s Hospital Boston said. “Our overall incidence of 11.6% is almost three times higher than was seen previously reported in the literature.”
Tibial shaft fractures are a common childhood injury, Shore said. They are the third most common long bone fracture after forearm and femur fractures. He noted that diagnosing compartment syndrome in these patients can be challenging.
Shore and colleagues completed a detailed, 5-year retrospective chart review of 216 tibial shaft fractures treated at a major pediatric hospital. The researchers used multivariate logistic regression analysis to test age, gender, mechanism of injury, time to surgery, fracture type and intervention as potential compartment syndrome risk factors.
The trial included 212 children, 160 of whom were boys. The patients had a mean age of 13.1 years and a mean clinical follow up of 7 months. More than 50% of the injuries were sports-related, 25% were caused by motor vehicle accidents, and 20% were caused by falls from a height greater than 10 feet, said Shore, who presented the results during 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons in San Diego.
Sports activity
There were 25 cases of compartment syndrome in 24 children. Half of the cases in the compartment syndrome group were made from clinical diagnosis, while the other half was diagnosed with pressure testing, Shore said.
There were equal numbers of patients managed with titanium elastic nails, external fixators and intramedullary nails.
“Not surprisingly, about 70% of the non-compartment syndrome group was managed with closed reduction and casting,” Shore said.
The anterior and lateral compartments were the most commonly involved compartments, he said.
Ninety-two patients returned to their pre-injury level of sports activity. There were some complications: one child required a below-knee amputation for a missed compartment syndrome secondary to a vascular injury, Shore said. Three cases of osteomyelitis required repeat surgical debridement and intravenous antibiotics. The single nonunion was treated with a locked intramedullary nail. Three cases of compartment syndrome required soft tissue grafting.
Key predictors
The critical predictors of compartment syndrome were an age of 14 years and older and involvement in a motor vehicle collision.
Patients aged 14 years and older who were involved in a motor vehicle accident had a significantly higher risk of compartment syndrome, Shore said. “It was much higher than was previously thought by our group.
“Children greater than 14 [years old] involved in a motor vehicle collision had a five-fold increase in the baseline, at almost 55%,” Shore continued. “Careful assessment of these children at risk for developing compartment syndrome is fundamental for recognition and early prevention.”
The investigators found that neither gender, AO fracture type, time to surgery nor surgical fixation were predictive of compartment syndrome. – by Colleen Owens
Reference:
- Shore B. Compartment syndrome in pediatric tibial shaft fractures: Incidence and multivariate risk factors. Paper #168. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
- Benjamin J. Shore, MD, FRCSC, can be reached at Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115; 617-355-6021; email: benjamin.shore@childrens.harvard.edu.
- Disclosure: Shore has no relevant financial disclosures.