• J Orthop Trauma · Nov 2013

    Acute compartment syndrome in children and teenagers with tibial shaft fractures: incidence and multivariable risk factors.

    • Benjamin J Shore, Michael P Glotzbecker, David Zurakowski, Estee Gelbard, Daniel J Hedequist, and Travis H Matheney.
    • Departments of *Orthopaedic Surgery; and †Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, MA.
    • J Orthop Trauma. 2013 Nov 1; 27 (11): 616-21.

    ObjectivesTo identify the incidence of acute compartment syndrome (ACS) in children and teenagers with tibial shaft fractures and report associated risk factors.DesignRetrospective Case Control.SettingLevel 1 pediatric trauma hospital.Patients/ParticipantsTwo hundred sixteen tibial shaft fractures in 212 patients (160 males and 52 females; median age, 13 years) over a 5-year period were reviewed.InterventionOne hundred thirty-two (61%) fractures were treated with closed reduction and casting, 36 with external fixation, 27 with locked intramedullary nails, and 21 with flexible intramedullary nails.Main Outcome MeasuresACS was diagnosed clinically or by intracompartment pressure. Multivariable logistic regression analysis tested age, gender, weight, physeal status, mechanism of injury, time to surgery, fracture type, and treatment intervention as possible risk factors for development of ACS.ResultsThere were 25 (11.6%) cases of ACS. Multivariable predictors of ACS included age of 14 years and older (22/96 = 23% vs. 3/120 = 3%, P < 0.001) and motor vehicle accident (MVA) (13/57 = 23% vs. 12/159 = 8%, P < 0.001). Incidence of ACS was 48% among patients aged 14 years and older, who sustained MVA (12/25). Gender, physeal status, time to surgery, and surgical fixation were not predictive of ACS.ConclusionsThis is the largest study in children and teenagers reporting the incidence of ACS from tibial shaft fractures. The incidence of 11.6% is higher than previously reported and much higher in patients older than14 years of age and involved in an MVA. Surgeons should be especially aware and suspicious of this diagnosis in teenagers with tibial shaft fractures.Level Of EvidencePrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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