Compartment syndrome in dislocation and non-dislocation type proximal tibia fractures: analysis of 356 consecutive cases.

INTRODUCTION: Dislocation type proximal tibia fractures are associated with the major soft tissue injuries. The main purpose of this study was to analyze the incidence of compartment syndrome (CS) in proximal tibia fractures in relation to the fracture type, i.e., dislocation versus non-dislocation type. We further analyzed CS within the non-dislocation type injuries, initial treatment modality as well as infection rate relative to the treatment policies (one- or two-staged procedures).

PATIENTS AND METHODS: Over an 8.5-year period, prospectively, acquired data of 356 proximal tibia fractures were evaluated. All fractures were classified either according to the AO/OTA or to the Moore (fracture dislocation type) classification system respectively. The appearance of CS in dislocation and non-dislocation type injuries as well as treatment modality, i.e., one- or two-staged procedures was analyzed.

RESULTS: 307 (86%) fractures were classified as non-dislocation type and 49 (14%) as fracture dislocation type injuries. Overall 31 (8.7%) CS occurred. All were diagnosed and treated within the initial surgical management. CS was equally distributed in non-dislocation type fractures (24/307) and Moore type fractures (7/49) (Chi-square test, p = 0.4). But a significant difference in the non-dislocation type injuries was observed between AO/OTA B-type (0/166) and non-B type fractures (24/117) (Chi-square test, p < 0.001). 104 fractures were treated in a two-staged procedure with definitive reconstruction after an average of 6.0 days. Initial postoperative surgical site infection remained very low with 0.5%, and did not seem to be related to operative treatment variables including single-stage versus two-stage reconstruction, temporary external fixation and/or compartment fasciotomies.

CONCLUSION: The incidence for CS did not differ between the dislocation and non-dislocation type group, but a significant difference was found comparing the incidence for CS only in the non-dislocation type group.