Beebe MJ, et al. - This study investigated the correlation between the OTA/AO classification of tibia fractures and the development of acute compartment syndrome (ACS). Findings demonstrated that age, sex, and OTA/AO classification were highly predictive for the development of ACS in a large cohort of tibia fractures.

Methods

• Researchers performed a retrospective review of prospectively collected database at single Level 1 academic trauma center.
• They reviewed all patients with a tibia fracture from 2006 to 2016.
• Initially, they identified 3,606 fractures.
• They also included in this study skeletally mature patients with plate or intramedullary fixation managed from initial injury through definitive fixation at their institution, leaving 2885 fractures in 2778 patients.
• After database and chart review, they performed univariate analyses using independent t tests for continuous data and Χ² tests of independence for categorical data.
• In order to identify variables significantly associated with ACS, a simultaneous multivariate binary logistic regression was developed.

Results

• The occurrence of ACS was reported in 136 limbs (4.7%).
• 36.2 years was reported as the average age, compared with 43.3 years in those without ACS (P < 0.001).
• Progression to ACS was 1.7 times more likely in men vs. women (P = 0.012).
• ACS development was 1.9 times more likely in patients who underwent external fixation (P = 0.003).
• Researchers noted that OTA/AO 43 injuries were at least 4.0 times less likely to foster ACS vs OTA/AO 41 or 42 injuries (P < 0.007).
• They also observed that compared with OTA/AO 41-A (P = 0.03), OTA/AO 41-C injuries were 5.5 times more likely to advance to ACS.
• Additionally, it was evident that compared with OTA/AO 42-A fractures, there was a significantly higher rate of ACS in OTA/AO 42-B (P = 0.005) and OTA/AO 42-C (P = 0.002) fractures.
• In the distal segment, the risk of ACS was not predicted by the fracture type (P > 0.15).
• A lower rate of ACS was observed in Group 1 fractures vs. group 2 (P = 0.03) and group 3 (P = 0.003) fractures in the middle segment only.
• Data showed that bilateral tibia fractures had a 2.7 times lower rate of ACS (P = 0.04).
• ACS was not predicted by open injury, multiple segment injury, fixation type, and concurrent pelvic or femoral fractures.