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Published in: European Journal of Trauma and Emergency Surgery 5/2020

01-10-2020 | Tibia Fracture | Original Article

Differences between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2020

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Abstract

Purpose

To analyze the differences in outcomes between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome (ACS).

Methods

From our trauma database, we identified a total of 107 patients with 126 fractures of AO/OTA type 41–44 and 120 ACS from January 01, 2001 to December 31, 2015 who were treated with primary or secondary definitive osteosynthesis after concomitant fasciotomy.

Results

Seventy-one patients with 77 fractures of AO/OTA classification type 41–44 suffering ACS received primary definitive osteosynthesis at the time of compartmental incision (POCI) and were compared to 36 patients with 49 fractures of AO/OTA type 41–44 and ACS, who received secondary definitive osteosynthesis after compartmental incision and soft tissue coverage (SOCI). Patients with POCI had a significantly shorter length of hospital stay with significantly fewer necessary surgeries to achieve definitive fracture treatment and soft tissue closure than SOCI patients (p ≤ 0.001). The overall rate of infections in both groups was 13%, without any difference between POCI and SOCI.

Conclusions

POCI for AO/OTA fractures type 41–44 with ACS is a safe and effective procedure without increasing the infection rate compared to a gradual treatment (SOCI). However, the possible selection bias due to the retrospective study design needs to be considered.
Literature
1.
go back to reference Allmon C, Greenwell P, Paryavi E, Dubina A, OʼToole RV. Radiographic predictors of compartment syndrome occurring after tibial fracture. J Orthop Trauma. 2016;30(7):387–91.CrossRefPubMed Allmon C, Greenwell P, Paryavi E, Dubina A, OʼToole RV. Radiographic predictors of compartment syndrome occurring after tibial fracture. J Orthop Trauma. 2016;30(7):387–91.CrossRefPubMed
2.
go back to reference Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res. 2010;468(4):940–50.CrossRefPubMed Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res. 2010;468(4):940–50.CrossRefPubMed
3.
go back to reference McQueen MM, Duckworth AD, Aitken SA, Sharma RA, Court-Brown CM. Predictors of compartment syndrome after tibial fracture. J Orthop Trauma. 2015;29(10):451–5.CrossRefPubMed McQueen MM, Duckworth AD, Aitken SA, Sharma RA, Court-Brown CM. Predictors of compartment syndrome after tibial fracture. J Orthop Trauma. 2015;29(10):451–5.CrossRefPubMed
4.
go back to reference Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005;13(7):436–44.CrossRefPubMed Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005;13(7):436–44.CrossRefPubMed
5.
go back to reference Park S, Ahn J, Gee AO, Kuntz AF, Esterhai JL. Compartment syndrome in tibial fractures. J Orthop Trauma. 2009;23(7):514–8.CrossRefPubMed Park S, Ahn J, Gee AO, Kuntz AF, Esterhai JL. Compartment syndrome in tibial fractures. J Orthop Trauma. 2009;23(7):514–8.CrossRefPubMed
6.
go back to reference Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O’Brien PJ. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol. 2015;16(3):185–92.CrossRefPubMed Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O’Brien PJ. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol. 2015;16(3):185–92.CrossRefPubMed
7.
go back to reference Stark E, Stucken C, Trainer G, Tornetta P. Compartment syndrome in Schatzker type VI plateau fractures and medial condylar fracture-dislocations treated with temporary external fixation. J Orthop Trauma. 2009;23(7):502–6.CrossRefPubMed Stark E, Stucken C, Trainer G, Tornetta P. Compartment syndrome in Schatzker type VI plateau fractures and medial condylar fracture-dislocations treated with temporary external fixation. J Orthop Trauma. 2009;23(7):502–6.CrossRefPubMed
8.
go back to reference von Keudell AG, Weaver MJ, Appleton PT, Appelton PT, Bae DS, Dyer GS, Heng M, Jupiter JB, Vrahas MS. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015;386(10000):1299–310.CrossRef von Keudell AG, Weaver MJ, Appleton PT, Appelton PT, Bae DS, Dyer GS, Heng M, Jupiter JB, Vrahas MS. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015;386(10000):1299–310.CrossRef
9.
go back to reference Arnscheidt C. Advanced trauma life support (ATLS). First german edition. Munich: American College of Surgeons; 2015. Arnscheidt C. Advanced trauma life support (ATLS). First german edition. Munich: American College of Surgeons; 2015.
10.
go back to reference Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed
11.
go back to reference Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am. 1976;58(4):453–8.CrossRef Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am. 1976;58(4):453–8.CrossRef
12.
go back to reference Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742–6.CrossRefPubMed Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742–6.CrossRefPubMed
13.
go back to reference Tscherne H, Oestern HJ. A new classification of soft-tissue damage in open and closed fractures (author’s transl). Unfallheilkunde. 1982;85(3):111–5.PubMed Tscherne H, Oestern HJ. A new classification of soft-tissue damage in open and closed fractures (author’s transl). Unfallheilkunde. 1982;85(3):111–5.PubMed
14.
go back to reference Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606–8.CrossRefPubMed Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606–8.CrossRefPubMed
15.
go back to reference Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury. 2007;38(Suppl 2):19–22.CrossRef Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury. 2007;38(Suppl 2):19–22.CrossRef
16.
go back to reference Weber B, Cech O. Pseudarthrosis: pathology, biomechanics, results. New York: Grune and Stratton; 1976. Weber B, Cech O. Pseudarthrosis: pathology, biomechanics, results. New York: Grune and Stratton; 1976.
17.
go back to reference Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):1–133.CrossRef Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):1–133.CrossRef
18.
go back to reference Heckman MM, Whitesides TE, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Jt Surg Am. 1994;76(9):1285–92.CrossRef Heckman MM, Whitesides TE, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Jt Surg Am. 1994;76(9):1285–92.CrossRef
19.
go back to reference McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Jt Surg Br. 1996;78(1):99–104.CrossRef McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Jt Surg Br. 1996;78(1):99–104.CrossRef
20.
go back to reference Mubarak SJ, Owen CA. Double-incision fasciotomy of the leg for decompression in compartment syndromes. J Bone Jt Surg Am. 1977;59(2):184–7.CrossRef Mubarak SJ, Owen CA. Double-incision fasciotomy of the leg for decompression in compartment syndromes. J Bone Jt Surg Am. 1977;59(2):184–7.CrossRef
21.
go back to reference Krause M, Müller G, Frosch KH. Surgical approaches to tibial plateau fractures. Unfallchirurg. 2018;121(7):569–82.CrossRefPubMed Krause M, Müller G, Frosch KH. Surgical approaches to tibial plateau fractures. Unfallchirurg. 2018;121(7):569–82.CrossRefPubMed
22.
go back to reference Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005;19(7):448–55 (discussion 456).CrossRefPubMed Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005;19(7):448–55 (discussion 456).CrossRefPubMed
23.
go back to reference Benirschke SK, Agnew SG, Mayo KA, Santoro VM, Henley MB. Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol. J Orthop Trauma. 1992;6(1):78–86.PubMed Benirschke SK, Agnew SG, Mayo KA, Santoro VM, Henley MB. Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol. J Orthop Trauma. 1992;6(1):78–86.PubMed
24.
go back to reference Gershuni DH, Mubarak SJ, Yaru NC, Lee YF. Fracture of the tibia complicated by acute compartment syndrome. Clin Orthop Relat Res. 1987;217:221–7. Gershuni DH, Mubarak SJ, Yaru NC, Lee YF. Fracture of the tibia complicated by acute compartment syndrome. Clin Orthop Relat Res. 1987;217:221–7.
25.
go back to reference Hak DJ, Johnson EE. The use of the unreamed nail in tibial fractures with concomitant preoperative or intraoperative elevated compartment pressure or compartment syndrome. J Orthop Trauma. 1994;8(3):203–11.CrossRefPubMed Hak DJ, Johnson EE. The use of the unreamed nail in tibial fractures with concomitant preoperative or intraoperative elevated compartment pressure or compartment syndrome. J Orthop Trauma. 1994;8(3):203–11.CrossRefPubMed
26.
go back to reference Schmidt AH. The impact of compartment syndrome on hospital length of stay and charges among adult patients admitted with a fracture of the tibia. J Orthop Trauma. 2011;25(6):355–7.CrossRefPubMed Schmidt AH. The impact of compartment syndrome on hospital length of stay and charges among adult patients admitted with a fracture of the tibia. J Orthop Trauma. 2011;25(6):355–7.CrossRefPubMed
27.
go back to reference Dubina AG, Paryavi E, Manson TT, Allmon C, O’Toole RV. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome. Injury. 2017;48(2):495–500.CrossRefPubMed Dubina AG, Paryavi E, Manson TT, Allmon C, O’Toole RV. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome. Injury. 2017;48(2):495–500.CrossRefPubMed
28.
go back to reference Blair JA, Stoops TK, Doarn MC, Kemper D, Erdogan M, Griffing R, Sagi HC. Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures: a matched cohort comparison. J Orthop Trauma. 2016;30(7):392–6.CrossRefPubMed Blair JA, Stoops TK, Doarn MC, Kemper D, Erdogan M, Griffing R, Sagi HC. Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures: a matched cohort comparison. J Orthop Trauma. 2016;30(7):392–6.CrossRefPubMed
29.
go back to reference Hak DJ, Lee M, Gotham DR. Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures. J Trauma. 2010;69(4):886–8.CrossRefPubMed Hak DJ, Lee M, Gotham DR. Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures. J Trauma. 2010;69(4):886–8.CrossRefPubMed
30.
go back to reference Bible JE, McClure DJ, Mir HR. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome. J Orthop Trauma. 2013;27(11):607–11.CrossRefPubMed Bible JE, McClure DJ, Mir HR. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome. J Orthop Trauma. 2013;27(11):607–11.CrossRefPubMed
31.
go back to reference Zura RD, Adams SB, Jeray KJ, Obremskey WT, Stinnett SS, Olson SA, Foundation SFC. Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma. 2010;69(6):1523–6.CrossRefPubMed Zura RD, Adams SB, Jeray KJ, Obremskey WT, Stinnett SS, Olson SA, Foundation SFC. Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection. J Trauma. 2010;69(6):1523–6.CrossRefPubMed
32.
go back to reference Sharma N, Singh V, Agrawal A, Bhargava R. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: a retrospective analysis of 15 cases. Indian J Orthop. 2015;49(5):502–9.CrossRefPubMedPubMedCentral Sharma N, Singh V, Agrawal A, Bhargava R. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: a retrospective analysis of 15 cases. Indian J Orthop. 2015;49(5):502–9.CrossRefPubMedPubMedCentral
Metadata
Title
Differences between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome
Publication date
01-10-2020
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01089-2

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