• Tyler Noble, Nicholas M Romeo, Christopher T LeBrun, and Thomas DiPasquale.
• *Department of Orthopaedic Surgery, Wellspan York Hospital, York, PA; †Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA; and ‡Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
• J Orthop Trauma. 2017 Nov 1; 31 (11): e381-e384.

ObjectivesTo determine the incidence of vacuum phenomenon related intra-articular or subfascial gas found on computer-assisted tomography (CT) scans of closed lower extremity fractures.DesignRetrospective Review.SettingLevel I Trauma Center.Patients/ParticipantsA total of 153 patients with closed lower extremity fractures.InterventionCT scans of identified individuals were reviewed for the presence or absence of gaseous accumulations.Main Outcome MeasurementsThe presence or absence of gas on CT.ResultsTwenty seven (17.6%) of the 153 fractures were found to have intra-articular or subfascial gas on CT despite clear documentation, indicating a closed injury with no significant skin compromise. Of the intra-articular fractures (OTA/AO 33B/C, 41B/C and 43B/C), 20% (23 of 113) were found to have gas on CT. All cases were associated with fracture of the tibia (P = 0.002).ConclusionsComputed tomography demonstrated the presence of intra-articular or subfascial gas in 17.6% (27/153) of closed lower extremity fractures and in 20% (23/113) of closed intra-articular fractures. The possibility of vacuum phenomenon must be considered when using this imaging modality as the confirmatory test for open intra-articular fracture or traumatic arthrotomy.Level Of EvidenceLevel IV.

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