• James A Blair, Thomas Kyle Stoops, Michael C Doarn, Dan Kemper, Murat Erdogan, Rebecca Griffing, and H Claude Sagi.
• *Department of Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX; †Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; ‡Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, FL; §Kaiser Permanente, Walnut Creek, CA; ‖Department of Orthopaedics and Traumatology, Ondokuz Mayis Üniversitesi, Samsun, Turkey; and ¶Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
• J Orthop Trauma. 2016 Jul 1; 30 (7): 392-6.

ObjectivesThe objective was to compare the rates of union and infection in patients treated with and without fasciotomy for acute compartment syndrome (ACS) in operatively managed tibia fractures.DesignThis was a retrospective review.SettingThe study was conducted at both a Level 1 and Level II trauma center.Patients/ParticipantsPatients operated for tibial plateau fractures (group 1) and tibial shaft fractures (group 3) with ACS requiring fasciotomy were matched to patients without ACS (plateau: group 2, shaft: group 4) in a 1:3 ratio for age, sex, fracture pattern, and open/closed injury.InterventionSurgical treatment was provided with plates/screws (plateau fractures) or intramedullary rod (shaft fractures). Patients with ACS were treated with a 2-incision 4-compartment fasciotomy.Main Outcome MeasurementsTime to union and incidence of deep infection, nonunion, and delayed union.ResultsOne hundred eighty-four patients were included-group 1: 23 patients, group 2: 69 patients, group 3: 23 patients, and group 4: 69 patients. Time to union averaged 26.8 weeks for groups 1 and 3 and 21.5 weeks for groups 2 and 4 (P > 0.05). Nonunion occurred in 20% for groups 1 and 3 and in 5% for groups 2 and 4 (P = 0.003). Deep infection developed in 20% for groups 1 and 3 and in 4% for groups 2 and 4 (P = 0.001). There was a significant increase in infection in group 1 versus group 2 and nonunion in group 3 versus group 4. There were significantly more smokers for those with fasciotomies (46%) than without (20%, P < 0.001), though all statistical results remained similar after a binary regression analysis.ConclusionFour-compartment fasciotomies in patients with tibial shaft or plateau fractures is associated with a significant increase in infection and nonunion.Level Of EvidencePrognostic level III. See Instructions for Authors for a complete description of levels of evidence.

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