Open or closed fracture of the tibial shaft is a common injury. There is no long-term outcome data of patients after tibial shaft fracture utilising modern treatment methods. This study assessed pain and function of 1509 consecutive patients with a tibial shaft fracture at 12–22 years following injury. Secondary outcomes included: effect on employment, effect of social deprivation, necessity for hardware removal and comparative morbidity following fasciotomy.

Prospective study of 1509 consecutive adult patients with a tibial shaft fracture (1990–1999) at a high-volume trauma unit. 1034 were male, and the mean age at injury was 40 years. Fractures were classified according to AO, and open fractures graded after Gustillo and Anderson. Time to fracture union, complication rate, hardware removal and incidence of anterior knee pain were recorded. Employment and assessment of social deprivation were detailed. Function was assessed at 12 to 22 years post injury using the Short Musculoskeletal Functional Assessment and Short Form 12 questionnaires.

87% of fractures united without further intervention. Social deprivation was associated with higher incidence of fracture and poorer functional and economic outcomes. 11.5% patients underwent fasciotomy which correlated with poorer long-term outcome. Tibial shaft fracture had high mortality in the elderly. At long-term follow-up 25% of patients have anterior knee pain and 20% ankle discomfort after IM nailing.

This is the largest and longest study assessing functional and economic outcomes of tibial shaft fracture. This is the first paper to describe ankle pain following tibial IM nailing at long-term follow-up.

This prospective clinical study investigates the relationship between intra-compartmental pressure and soft tissue oxygenation (StO2) measured non-invasively by near-infrared spectroscopy (NIRS) in patients at risk of acute compartment syndrome.

Patients (over 13 years) with fractures of the tibial diaphysis or high-energy fractures of the forearm or distal radius, or patients with soft tissue injury were recruited. Non-invasive and invasive monitoring was carried out pre and post operatively. The ‘Delta P’ value (DP) was calculated as the compartment pressure subtracted from the diastolic blood pressure. The threshold for fasciotomy was a DP < 30mmHg. Non-invasive tissue saturation measurements and pressure measurements were taken from the same compartment (anterior tibial or volar forearm). StO2 values were simultaneously recorded from the contralateral (uninjured) limb at the same anatomical site. All patients had the difference between the StO2 value on the injured and uninjured sides calculated (‘StO2 difference’).

42 patients with tibial diaphyseal fractures, 2 patients with forearm fractures and one case with thigh swelling were recruited to the study. The mean age was 40 years (SD 17 years). 11 patients underwent a four-compartment lower leg fasciotomy determined by a DP < 30mmHg. Patients who required a fasciotomy had an ‘StO2 difference’ that was 20% lower (p = 0. 002) compared to those who did not develop acute compartment syndrome. This suggests that patients who require a fasciotomy have reduced StO2 values on their injured legs compared to the contralateral (uninjured) side.

We have observed that non-invasive StO2 measurements for patients over 13 years at risk of acute compartment syndrome, correlates with the requirement for a fasciotomy as defined by P < 30mmHg. We are optimistic that near-infrared spectroscopy (NIRS) will be a reliable new non-invasive technique for detection of an acute compartment syndrome.