Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-01-2019 | Original Article • LOWER LIMB - FRACTURES

The impacts of internal versus external fixation for tibial fractures with simultaneous acute compartment syndrome

Authors: Hossein Akbari Aghdam, Erfan Sheikhbahaei, Hamidreza Hajihashemi, Davoud Kazemi, Ali Andalib

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 1/2019

Abstract

Purpose

High-energy tibial fractures may cause compartment syndrome, which needs fasciotomy. However, in this procedure, close fractures become an open wound and choosing the best type of fixation for this situation has been a problem. We assumed early open reduction and internal fixation (ORIF) instead of late internal fixation or external fixation, or stage-based approach is a better method.

Methods

We collected fifty-seven medical records from 2012 to 2017 stored in Alzahra and Kashani University Hospital databases. We selected important information of their medical files, called the submitted phone numbers, and asked them to come to our clinic and examined their leg for any malunion and/or movement restriction postoperatively. We asked about pain and paresthesia in their leg. Twelve cases were excluded.

Results

Demographic variables were not significantly different between these two groups. Deep infection, malunion, decreased range of motion in both knee and ankle joints, pain and paresthesia mainly occurred in external fixation group, except malunion (p value = 0.032), other variables were not statistically significant between two groups. More surgeries were performed predominantly for external fixation group (p value < 0.001). External fixation stayed 4.7 days longer at hospital although it was not statistically significant (p value = 0.108).

Conclusion

It is better to perform fasciotomy and ORIF simultaneously in one surgery to lower the number of surgeries, days of hospitalization, decrease the risk of deep infection, malunion and movement restriction although its postoperative outcomes were not considerably different from external fixation. We indicate that stage-based approach is accompanied by poor outcomes and lesser satisfaction.

Reverte MM, Dimitriou R, Kanakaris NK, Giannoudis PV (2011) What is the effect of compartment syndrome and fasciotomies on fracture healing in tibial fractures? Injury 42(12):1402–1407. https://doi.org/10.1016/j.injury.2011.09.007 CrossRefPubMed

Haller JM, Holt D, Rothberg DL, Kubiak EN, Higgins TF (2016) Does early versus delayed spanning external fixation impact complication rates for high-energy tibial plateau and plafond fractures? Clin Orthop Relat Res 474(6):1436–1444. https://doi.org/10.1007/s11999-015-4583-4 CrossRefPubMed

Crist BD, Della Rocca GJ, Stannard JP (2010) Compartment syndrome surgical management techniques associated with tibial plateau fractures. J Knee Surg 23(1):3–7CrossRefPubMed

Goyal S, Naik MA, Tripathy SK, Rao SK (2017) Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure. World J Orthop 8(5):385. https://doi.org/10.5312/wjo.v8.i5.385 CrossRefPubMedPubMedCentral

Beebe MJ, Auston DA, Quade JH, Serrano-Riera R, Shah AR, Watson DT et al (2017) OTA/AO classification is highly predictive of acute compartment syndrome after tibia fracture. J Orthop Trauma 31(11):600–605. https://doi.org/10.1097/BOT.0000000000000918 CrossRefPubMed

Metcalfe D, Hickson CJ, McKee L, Griffin XL (2015) External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol 16(4):275–285. https://doi.org/10.1007/s10195-015-0372-9 CrossRefPubMedPubMedCentral

Lin S, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ (2014) Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur J Orthop Surg Traumatol 24(5):797–803. https://doi.org/10.1007/s00590-013-1252-8 CrossRefPubMed

Zhao X, Ma J, Ma X, Jiang X, Wang Y, Li F, Lu B (2017) A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures. Int J Surg 39:65–73. https://doi.org/10.1016/j.ijsu.2017.01.044 CrossRefPubMed

Zura RD, Adams SB, Jeray KJ, Obremskey WT, Stinnett SS, Olson SA (2010) Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma Inj Infect Crit Care 69(6):1523–1526. https://doi.org/10.1097/TA.0b013e3181d40403 CrossRef

10.

Kim TH, Chung JY, Kim KS, Song HK (2017) Is external fixation needed for the treatment of tibial fractures with acute compartment syndrome? Injury. https://doi.org/10.1016/j.injury.2017.11.018 CrossRefPubMed

11.

Morris BJ, Unger RZ, Archer KR, Mathis SL, Perdue AM, Obremskey WT (2013) Risk factors of infection after ORIF of bicondylar tibial plateau fractures. J Orthop Trauma 27(9):e196–e200. https://doi.org/10.1097/BOT.0b013e318284704e CrossRefPubMed

12.

Momaya AM, Hlavacek J, Etier B, Johannesmeyer D, Oladeji LO, Niemeier TE et al (2016) Risk factors for infection after operative fixation of Tibial plateau fractures. Injury 47(7):1501–1505. https://doi.org/10.1016/j.injury.2016.04.011 CrossRefPubMed

13.

Gamulin A, Lübbeke A, Belinga P, Hoffmeyer P, Perneger TV, Zingg M, Cunningham G (2017) Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study. BMC Musculoskelet Disord 18(1):307. https://doi.org/10.1186/s12891-017-1680-4 CrossRefPubMedPubMedCentral

14.

Shao J, Chang H, Zhu Y, Chen W, Zheng Z, Zhang H, Zhang Y (2017) Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: a systematic review and meta-analysis. Int J Surg 41:176–182. https://doi.org/10.1016/j.ijsu.2017.03.085 CrossRefPubMed

15.

Blair JA, Stoops TK, Doarn MC, Kemper D, Erdogan M, Griffing R, Sagi HC (2016) Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures. J Orthop Trauma 30(7):392–396. https://doi.org/10.1097/BOT.0000000000000570 CrossRefPubMed

16.

Hak DJ, Lee M, Gotham DR (2010) Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures. J Trauma Inj Infect Crit Care 69(4):886–888. https://doi.org/10.1097/TA.0b013e3181b83fe9 CrossRef

Title: The impacts of internal versus external fixation for tibial fractures with simultaneous acute compartment syndrome
Authors: Hossein Akbari Aghdam
Erfan Sheikhbahaei
Hamidreza Hajihashemi
Davoud Kazemi
Ali Andalib
Publication date: 01-01-2019
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 1/2019
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-018-2275-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impacts of internal versus external fixation for tibial fractures with simultaneous acute compartment syndrome

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Analysis of risk factors for perioperative mortality in elderly patients with intertrochanteric fracture

A prospective clinical trial to assess the accuracy of an MRI-based patient-specific acetabular instrument guide in total hip arthroplasty

Undisplaced femoral neck fractures need a closed reduction before internal fixation

Uncemented total hip arthroplasty in octogenarian and nonagenarian patients

Sacral chordoma: clinical experience of a series of 11 patients over 18 years

The clinical relevance of PCL index on the reconstruction of anterior cruciate ligament with hamstring tendon autograft