• Margaret M McQueen, Andrew D Duckworth, Stuart A Aitken, Rowena A Sharma, and Charles M Court-Brown.
• *Department of Orthopaedic Trauma, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom; and †Obstetrics and Gynaecology, North West London Hospitals, London, United Kingdom.
• J Orthop Trauma. 2015 Oct 1; 29 (10): 451-5.

ObjectivesThe aim of our study was to identify the risk factors associated with the development of acute compartment syndrome (ACS) after a fracture of the tibia.DesignRetrospective cohort study.SettingOrthopaedic trauma unit, university teaching hospital.PatientsFrom our trauma database, we identified all patients who sustained an acute tibial diaphyseal fracture over a 13-year period. A retrospective analysis of 1407 patients was performed to record and analyze the OTA fracture classification, open fracture grade according to Gustilo, soft tissue injury classification according to Tscherne, treatment, development of ACS, and other patient demographics including smoking, occupation, and socioeconomic deprivation.Main Outcome MeasureA diagnosis of ACS was made using clinical signs, compartment pressure monitoring, or a combination of the 2.ResultsOne thousand three hundred eighty-eight patients were included with a mean age of 39 (12-98) years, and 957 (69%) were male. One hundred sixty patients (11.5%) were diagnosed with ACS. On initial analysis, age, male gender, blue-collar occupation, sporting injury, fracture classification, and treatment with intramedullary nails were predictive of ACS (all P < 0.05). Age was the strongest predictor of developing ACS (P < 0.001), with the highest prevalence between 12-19 years and 20-29 years. Occupation (P = 0.01) and implant type (P = 0.004) were the only factors that remained significant after adjusting for age. On further subanalysis, implant type was not predictive when stratified by Tscherne class (P = 0.11).ConclusionsWe have documented the risk factors for the development of ACS after an acute tibial diaphyseal fracture, with youth the strongest predictor.Level Of EvidencePrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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