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Archives of Orthopaedic and Trauma Surgery

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01-02-2012 | Trauma Surgery

Compartment syndrome in dislocation and non-dislocation type proximal tibia fractures: analysis of 356 consecutive cases

Authors: Yves P. Acklin, Primoz Potocnik, Christoph Sommer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2012

Abstract

Introduction

Dislocation type proximal tibia fractures are associated with the major soft tissue injuries. The main purpose of this study was to analyze the incidence of compartment syndrome (CS) in proximal tibia fractures in relation to the fracture type, i.e., dislocation versus non-dislocation type. We further analyzed CS within the non-dislocation type injuries, initial treatment modality as well as infection rate relative to the treatment policies (one- or two-staged procedures).

Patients and methods

Over an 8.5-year period, prospectively, acquired data of 356 proximal tibia fractures were evaluated. All fractures were classified either according to the AO/OTA or to the Moore (fracture dislocation type) classification system respectively. The appearance of CS in dislocation and non-dislocation type injuries as well as treatment modality, i.e., one- or two-staged procedures was analyzed.

Results

307 (86%) fractures were classified as non-dislocation type and 49 (14%) as fracture dislocation type injuries. Overall 31 (8.7%) CS occurred. All were diagnosed and treated within the initial surgical management. CS was equally distributed in non-dislocation type fractures (24/307) and Moore type fractures (7/49) (Chi-square test, p = 0.4). But a significant difference in the non-dislocation type injuries was observed between AO/OTA B-type (0/166) and non-B type fractures (24/117) (Chi-square test, p < 0.001). 104 fractures were treated in a two-staged procedure with definitive reconstruction after an average of 6.0 days. Initial postoperative surgical site infection remained very low with 0.5%, and did not seem to be related to operative treatment variables including single-stage versus two-stage reconstruction, temporary external fixation and/or compartment fasciotomies.

Conclusion

The incidence for CS did not differ between the dislocation and non-dislocation type group, but a significant difference was found comparing the incidence for CS only in the non-dislocation type group.

Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104

Moore TM (1981) Fracture–dislocation of the knee. Clin Orthop Relat Res 156:128–140

Kennedy JC, Bailey WH (1968) Experimental tibial-plateau fractures. Studies of the mechanism and a classification. J Bone Joint Surg Am 50(8):1522–1534PubMed

Wahlquist M, Iaguilli N, Ebraheim N et al (2007) Medial tibial plateau fractures: a new classification system. J Trauma 63(6):1418–1421PubMedCrossRef

Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 292:87–100

Egol KA, Tejwani NC, Capla EL et al (2005) Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma 19(7):448–455PubMedCrossRef

Prayson MJ, Chen JL, Hampers D et al (2006) Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome. J Trauma 60(5):1037–1040PubMedCrossRef

Stark E, Stucken C, Trainer G et al (2009) Compartment syndrome in Schatzker type VI plateau fractures and medial condylar fracture-dislocations treated with temporary external fixation. J Orthop Trauma 23(7):502–506PubMedCrossRef

Sheridan GW, Matsen FA III (1976) Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am 58(1):112–115PubMed

10.

Giannoudis PV, Nicolopoulos C, Dinopoulos H et al (2002) The impact of lower leg compartment syndrome on health related quality of life. Injury 33(2):117–121PubMedCrossRef

11.

Matsen FA 3rd, Winquist RA, Krugmire RB Jr (1980) Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am 62(2):286–291PubMed

12.

Whitesides TE, Heckman MM (1996) Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg 4(4):209–218PubMed

13.

Whitesides TE Jr, Haney TC, Harada H et al (1975) A simple method for tissue pressure determination. Arch Surg 110(11):1311–1313PubMedCrossRef

14.

Heppenstall RB, Sapega AA, Scott R et al (1988) The compartment syndrome. An experimental and clinical study of muscular energy metabolism using phosphorus nuclear magnetic resonance spectroscopy. Clin Orthop Relat Res 226:138–155

15.

Tiwari A, Haq AI, Myint F et al (2002) Acute compartment syndromes. Br J Surg 89(4):397–412PubMedCrossRef

16.

Park S, Ahn J, Gee AO et al (2009) Compartment syndrome in tibial fractures. J Orthop Trauma 23(7):514–518PubMedCrossRef

17.

Egol KA, Bazzi J, McLaurin TM et al (2008) The effect of knee-spanning external fixation on compartment pressures in the leg. J Orthop Trauma 22(10):680–685PubMedCrossRef

Title: Compartment syndrome in dislocation and non-dislocation type proximal tibia fractures: analysis of 356 consecutive cases
Authors: Yves P. Acklin
Primoz Potocnik
Christoph Sommer
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1408-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Compartment syndrome in dislocation and non-dislocation type proximal tibia fractures: analysis of 356 consecutive cases

Abstract

Introduction

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusion

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