Fasciotomy for Acute Compartment Syndrome Associated with Tibia Shaft Fractures in the United States

Background: Acute Compartment Syndrome (ACS) is devastating complication of extremity injuries, most commonly associated with tibia fractures. The only known treatment for ACS of the leg muscle compartments is a four-compartment fasciotomy. The goal of this study was to assess the frequency and timing of fasciotomy performed for acute compartment syndrome in association with tibia fractures. Our hypothesis was that fasciotomy is performed within the first 48 hours after injury in alert and awake patients and that this time would increase in comatose patients.

Methods: The United States National Trauma Databank (NTDB) was queried for patients that underwent fasciotomy in tibia fractures associated with ACS during 2015. The percent of fractures that were associated with fasciotomies, time to fasciotomy, level of consciousness according to the Glasgow Coma Scale (GCS), and duration of mechanical ventilation (when relevant) were recorded. Fractures associated with vascular injuries were excluded from the study. Descriptive statistics and student’s t-test were used to analyze the data.

Results: 917865 patients were included in the 2015 NTDB dataset. There were 28665 patients with midshaft tibia fracture, 18908 of them had isolated tibia fractures, and 713 (3.8%) of them underwent fasciotomy. Tibia shaft fractures were the most common fracture to be associated with fasciotomy (Table 1). Fasciotomies were more common in the younger age group and in men more than women (Figure 1). Time from arrival to the emergency room to fasciotomy increased from 31.72 ± 4.02 in patients with a GCS of 14-15, to 64.40 ± 8.3 in patients who underwent mechanical ventilation for one or more days (P<0.05).

Conclusions: Tibia fractures are the most common fracture to be associated with fasciotomy. Young males are the population at highest risk to undergo fasciotomy. Comatose patients may be at risk for delayed diagnosis of ACS and delayed fasciotomy.