COMPARTMENT SYNDROME FOLLOWING DIAPHYSEAL TIBIAL FRACTURES IN A REGIONAL TRAUMA UNIT – RISK FACTORS AND OUTCOME

Abstract

Introduction: Compartment syndrome is a well recognised complication of tibial diaphyseal fractures. The sequelae of late treatment can be devastating to both patient and surgeon. The aim of this study was to identify the incident, outcome and possible risk factors of compartment syndrome treated in a regional trauma unit.

Patients and Methods: A total of six hundred and twenty three tibial diaphyseal fractures were managed over a four year period (1995–1999). Two hundred and forty three of these were treated using a reamed intramedullary nail. One hundred and ninety four of these were closed and forty nine were open. AO radiological classification and Tscherne soft tissue classification were used to grade severity of injury. The mechanism of injury was recorded for all tibial fractures. Patients who were diagnosed with compartment syndrome were clinically and radiologically evaluated.

Results: Compartment syndrome was diagnosed in seventeen cases with an average follow up of twenty eight months (range 8–48 months). This represented a rate of compartment syndrome of 2.7% of all tibial fractures but 6.9% of cases treated with a reamed tibial nail. The average age of patients was twenty four years (range 18–42 years). Fractures were closed in twelve cases and open in 5. Results in this group were good in ten cases, fair in four cases and poor in three cases (Edwards Classification). Six patients developed complications following fasciotomy including drop foot, equinus contracture, muscle weakness and MRSA infection. In patients with complications, the interval between onset of symptoms and decompression was greater than ten hours. All patients who developed compartment syndrome had been treated using a reamed intramedullary nail.

Discussion: There was a statistically significant association between the use of intramedullary reaming and development of compartment syndrome (p< .05). We recognised a hitherto undescribed trend of compartment syndrome following reamed intramedullary nailing of tibial fractures sustained during sport activity. This may relate to higher initial compartment pressure in this group at the time of fracture. Increased awareness may avoid the consequences of late treatment of compartment syndrome.