OBJECTIVES: To report the incidence of Acute Compartment Syndrome (ACS) after low-energy, ballistic tibial fractures and examine associations between injury mechanism, fracture location and morphology, and patient characteristics.
METHODS: Design: Retrospective Review Setting: Single-center, large, urban, level 1 trauma center Patient Selection Criteria: Consecutive skeletally mature patients presenting with a tibial fracture [OTA-41, OTA-42, OTA-43] were evaluated.
OUTCOME MEASURES AND COMPARISONS: Patients were stratified into blunt and ballistic fracture cohorts based on mechanism of injury. Patient sociodemographics, diagnosis of ACS, and established risk factors for the development of ACS (age, gender, fracture location, and morphology) were collected.
RESULTS: Over the study period, 281 patients were included. Study participants had a mean age of 37 years (range, 15-98) with the majority being male, (70%). Based on injury mechanism, 67% (n = 187) were blunt injuries, and 32% (n = 94) were ballistic injuries. Fractures were categorized according to the AO/OTA classification and included 69 [OTA-41], 163 [OTA-42], and 47 [OTA-43] fractures [1]. The overall incidence of ACS in this population was 2.1% (n = 6/281), with a incidence of 1% (n = 1/94) in the ballistic cohort and 2.7% (n = 5/187) in the blunt cohort. Mechanism of injury, sex, age, and open fractures did not show an association with the development of ACS. On multivariable regression, the presence of vascular injury was significantly associated with the development of ACS regardless of injury mechanism (p < 0.001).
CONCLUSIONS: The incidence of ACS in patients with low-energy gunshot fractures of the tibia was approximately 1% and mechanism of injury did not portend an increased risk for the development of ACS. Regardless, a high clinical suspicion for ACS is necessary when managing tibial fractures to avoid potentially devastating sequelae.
LEVEL OF EVIDENCE: Level III.
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