Infection and Nonunion After Fasciotomy for Compartment Syndrome Associated With Tibia Fractures: A Matched Cohort Comparison

• Published in: Journal of orthopaedic trauma Vol. 30; no. 7; pp. 392 - 396
• Main Authors: Blair, James A, Stoops, Thomas Kyle, Doarn, Michael C, Kemper, Dan, Erdogan, Murat, Griffing, Rebecca, Sagi, H Claude
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-07-2016
• Subjects: Adult; Age Distribution; Anterior Compartment Syndrome - etiology; Anterior Compartment Syndrome - surgery; Case-Control Studies; Fasciotomy - adverse effects; Fasciotomy - methods; Female; Follow-Up Studies; Fracture Fixation - adverse effects; Fracture Fixation - methods; Fractures, Open - complications; Fractures, Open - pathology; Fractures, Open - surgery; Fractures, Ununited - diagnosis; Fractures, Ununited - epidemiology; Humans; Incidence; Male; Middle Aged; Registries; Retrospective Studies; Risk Assessment; Sex Distribution; Surgical Wound Infection - diagnosis; Surgical Wound Infection - epidemiology; Tibial Fractures - complications; Tibial Fractures - pathology; Tibial Fractures - surgery
• ISSN: 0890-5339; 1531-2291
• DOI: 10.1097/BOT.0000000000000570

OBJECTIVES:The objective was to compare the rates of union and infection in patients treated with and without fasciotomy for acute compartment syndrome (ACS) in operatively managed tibia fractures.
DESIGN:This was a retrospective review.
SETTING:The study was conducted at both a Level 1 and Level II trauma center.
PATIENTS/PARTICIPANTS:Patients operated for tibial plateau fractures (group 1) and tibial shaft fractures (group 3) with ACS requiring fasciotomy were matched to patients without ACS (plateaugroup 2, shaftgroup 4) in a 1:3 ratio for age, sex, fracture pattern, and open/closed injury.
INTERVENTION:Surgical treatment was provided with plates/screws (plateau fractures) or intramedullary rod (shaft fractures). Patients with ACS were treated with a 2-incision 4-compartment fasciotomy.
MAIN OUTCOME MEASUREMENTS:Time to union and incidence of deep infection, nonunion, and delayed union.
RESULTS:One hundred eighty-four patients were included—group 123 patients, group 269 patients, group 323 patients, and group 469 patients. Time to union averaged 26.8 weeks for groups 1 and 3 and 21.5 weeks for groups 2 and 4 (P > 0.05). Nonunion occurred in 20% for groups 1 and 3 and in 5% for groups 2 and 4 (P = 0.003). Deep infection developed in 20% for groups 1 and 3 and in 4% for groups 2 and 4 (P = 0.001). There was a significant increase in infection in group 1 versus group 2 and nonunion in group 3 versus group 4. There were significantly more smokers for those with fasciotomies (46%) than without (20%, P < 0.001), though all statistical results remained similar after a binary regression analysis.
CONCLUSION:Four-compartment fasciotomies in patients with tibial shaft or plateau fractures is associated with a significant increase in infection and nonunion.
LEVEL OF EVIDENCE:Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.