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International Orthopaedics
Published in: International Orthopaedics 3/2021

01-03-2021 | Compartment Syndrome | Original Paper

The blister occurring in severe tibial plateau fractures (Schatzker V–VI) decreases the risk of acute compartment syndrome

Authors: Jialiang Guo, Ze Gao, Ling Wang, Chen Feng, Zhiyong Hou, Yingze Zhang

Published in: International Orthopaedics | Issue 3/2021

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Abstract

Background

Severe tibial plateau fractures may result in acute compartment syndrome (ACS) of the leg, which is always considered to be an orthopaedic emergency. Blistering is not an uncommon sign and may be related to decreased compartment pressure. No experiments on the risk of ACS based on the presence of blisters after tibial plateau fractures have been conducted, and controversies about the high rate of ACS in patients with tibial plateau fractures still exist.

Questions/purposes

This research retrospectively followed the bicondylar tibial plateau fractures treated with locking plates and verified if the risk of ACS was decreased after a blister was observed.

Methods

A total of 100 patients with closed tibial fractures (63 men and 37 women) were included and divided into with blister (group A, 40) and without blister groups (group B, 60). The creatine kinase (CK), BUN, and chloride levels were recorded on the first day after hospitalization. The hospitalization costs and injury to operation time were collected in the two groups. The Lysholm knee score and a visual analogue scale (VAS) for pain were used to assess the rehabilitation after follow-up. Clinical and serological results of ACS in the two groups were compared.

Results

There was significant delay in the time from injury to operation (11.0 ± 3.5 VS 7.6 ± 7.2, Z = − 3.771, P < 0.001) in the with blister (group A) and without blister groups (group B). The levels of chloride and BUN were significantly lower in the with blister group than in the without blister group (102.7 ± 3.0 VS 104.7 ± 2.57 mg/dL, Z = − 3.33, P = 0.001) (10.3 ± 2.5 VS 10.3 ± 2.8 mg/dL, Z = − 2.366, P = 0.018). There were no significant differences in the CK levels in the with blister and without blister groups (285.8 ± 202.6 VS 408.4 ± 633.6 U/L, Z = − 1.379, P = 0.168), but a trend of decreasing to normal was obvious in patients with blisters. There were no significant differences in the Lysholm knee score (40 VS 60, 80 ± 4.9 VS 79.8 ± 3.0, Z = − 0.872, P = 0.383), or the VAS (40 VS 60, 1.6 ± 0.7 VS 2.2 ± 1.3, Z = − 1.568, P = 0.117) for pain compared with patients without blisters.

Conclusion

In conclusion, the presence of blisters in patients with severe tibial plateau fractures decreases the pressure in the compartment. There was a significant improvement in serological results after blisters appeared, which may be related to the reason for the decreased pressure decreased, and conservative management is recommended for these patients.
Literature
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Metadata
Title
The blister occurring in severe tibial plateau fractures (Schatzker V–VI) decreases the risk of acute compartment syndrome
Authors
Jialiang Guo
Ze Gao
Ling Wang
Chen Feng
Zhiyong Hou
Yingze Zhang
Publication date
01-03-2021
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 3/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-020-04925-y

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