Fri., 10/14/11 Tibia, Paper #50, 11:20 am OTA-2011
Fasciotomy for Acute Compartmental Syndrome Increases the Incidence of Infection, Nonunion and Delayed Union of Operatively Treated Tibial Fractures
Dan Kemper, MD1; Alejandro Castellvi, BS1; Murat Erdogan, MD2; H. Claude Sagi, MD1;
1Florida Orthopaedic Institute, Tampa, Florida, USA;
2Ondokuz Mayis University, Samsun, Turkey
Purpose: This study was conducted to evaluate and compare the rates of union and secondary complications in patients treated with and without fasciotomy for acute compartment syndrome in operatively managed tibia fractures. Our hypothesis is that the presence of fasciotomy for compartment syndrome increases the risk for complications associated with the treatment of tibial fractures.
Methods: This study is a retrospective review of prospectively collected data from a Level 1 regional trauma center between January 2000 and August 2010 on 149 patients with acute compartment syndrome and concomitant operatively treated tibial fractures (group 1). Patients were excluded from the study if they were skeletally immature, Gustilo IIIC, or had incomplete medical records and insufficient follow up to determine time to union. 19 patients with a tibial plateau fracture and 18 patients with a fracture of the diaphysis were included in the analysis. A 1:4 matched control cohort was constructed for comparison against patients with similar fracture patterns without compartment syndrome or fasciotomy (group 2). Tibial plateau fractures were treated with plate fixation and tibial shaft fractures were treated with intramedullary nail fixation. All fasciotomies were 4-compartment and 2 incisions, with early internal fixation and staged closure of the fasciotomy sites. Data recorded included age, OTA fracture classification, Gustilo classification, time to union, presence of nonunion, secondary operations, incidence of infection, and smoking status.
Results: All results were internally controlled for age, injury pattern, and method of fixation. Group 1 tibial plateau fractures demonstrated union on average at 28 weeks; 48% had delayed union and 11%, nonunion. Group 2 tibial plateau fractures demonstrated union on average at 15 weeks; 12% with delayed union and 6%, nonunion. Late infection developed in 10% of group 1 tibial plateau fractures versus 5% in group 2. Tibial shaft fractures in group 1 demonstrated union at 30 weeks; 67% had delayed union and 22%, nonunion. Tibial shaft fractures in group 2 demonstrated union at an average of 19 weeks; 28% with delayed union and 1%, nonunion. Late infection developed in 17% of group 1 tibial shaft fractures versus 2% in group 2. All reported differences between groups 1 and 2 were statistically significant (P <0.05). Smoking status was strongly correlated with delayed union in both groups independent of presence or absence of compartment syndrome.
Conclusion: The presence of acute compartment syndrome and the need for fasciotomy in patients with either tibial shaft or tibial plateau fractures is associated with a significant increase in the rate of delayed union, nonunion, and deep infection.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.