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Incidence and risk factors for acute compartment syndrome in pediatric tibia fractures
Mitchel R Obey1, Maksim A Shlykov1, Katelin B Nickel2
1Department of Orthopaedic Surgery.
Insights
Acute compartment syndrome (ACS) in pediatric tibia fractures is rare but serious. Teenagers, open fractures, and motor vehicle crashes significantly increase ACS risk, with some cases diagnosed after hospital discharge.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Health Services Research
Background:
- Acute compartment syndrome (ACS) is a rare but severe complication following traumatic injuries in children.
- Tibia fractures are the most frequent cause of ACS in the pediatric population.
- Understanding incidence and risk factors is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine the incidence of ACS in pediatric patients with tibia fractures.
- To identify risk factors associated with the development of ACS in this population.
- To analyze the timing of ACS diagnosis, including delayed presentations.
Main Methods:
- Retrospective analysis of State Inpatient, Emergency Department, and Ambulatory Surgery Databases (2006-2015).
- Inclusion of pediatric patients (1-18 years) with tibia fractures.
- Utilized multivariable generalized estimating equations to identify risk factors for ACS.
Main Results:
- The overall incidence of ACS was 0.6% in pediatric tibia fractures, rising to 5.5% for open fractures.
- Increased risk of ACS was associated with older age (13-18 years), open fractures, and motor vehicle crash mechanisms.
- Delayed ACS diagnosis occurred in 7.4% of cases, more frequently in nonoperatively treated adolescents.
Conclusions:
- Pediatric tibia fractures carry a low but significant risk of ACS, particularly in older children and those with open fractures or MVC-related injuries.
- Risk stratification is essential, with specific attention to teenagers, open fractures, and MVC mechanisms.
- The potential for delayed ACS diagnosis necessitates ongoing vigilance even after initial discharge.
Abstract:
Acute compartment syndrome (ACS) is a rare complication following traumatic injuries in pediatric patients, and tibia fractures represent the most common cause of ACS. To determine the incidence and risk factors of developing ACS, State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, were used to retrospectively identify patients 1-18 years of age with tibia fractures from 2006 to 2015 (quarter 3). The HCUP Nationwide Emergency Department Sample for nationwide data was also queried. Multivariable generalized estimating equations models were used to determine risk factors associated with development of ACS. A total of 50 640 patients with tibia fractures were studied, and 309 cases of ACS were identified. The incidence of ACS was 0.6 and 5.5% in the all tibia and open tibia fracture groups, respectively. Twenty-three cases of ACS (7.4% of all ACS) were diagnosed after discharge from the index admission, which was more common in teens treated nonoperatively. Predictors of increased ACS risk in the all tibia fracture group included age 13-18 [relative risk (RR): 4.04)], open fractures (RR: 3.83), and motor vehicle crash (MVC) mechanism (RR: 5.69). Nationwide, open and operatively treated fractures had an increased ACS rate (3.98 and 5.51%, respectively). Teenagers, open fractures, and MVC mechanisms were most strongly associated with ACS. ACS can present in a delayed fashion, as evidenced by postindex cases.
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