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Factors associated with compartment syndrome after a tibial fracture in children
Nasim Ahmed1,2, Yen-Hong Kuo2,3
1Department of Surgery, Division of Trauma and Surgical Critical Care, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, USA.
Insights
Compartment syndrome (CS) in children with tibial fractures is a serious orthopedic emergency. Key risk factors include increased age, non-African American race, and associated crush or vascular injuries, aiding early identification and intervention.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Emergency Medicine
Background:
- Compartment syndrome (CS) is a critical orthopedic emergency following pediatric tibial fractures.
- Timely identification of high-risk patients is crucial to minimize potential morbidities.
Purpose of the Study:
- To identify significant risk factors associated with the development of CS after tibial fractures in pediatric patients.
- To inform clinical practice for early detection and management of CS in this population.
Main Methods:
- Retrospective analysis of the 2017-2019 Trauma Quality Improvement Program database.
- Inclusion of pediatric patients (<18 years) admitted with tibial fractures.
- Multivariable logistic regression to analyze demographic, injury, and associated injury characteristics in relation to CS development.
Main Results:
- CS developed in 1.1% (49/4492) of pediatric patients with tibial fractures.
- Increased age (AOR=1.157), non-African American race (AOR=2.238), crush injury (AOR=18.812), and vascular injury (AOR=3.509) were significantly associated with CS.
- Patients with CS had higher rates of crush (2% vs 0.1%) and vascular injuries (10.2% vs 2.2%).
Conclusions:
- Age, non-African American race, crush injury, and vascular injury are significant risk factors for CS after pediatric tibial fractures.
- These findings can guide risk stratification and prompt management strategies for pediatric tibial fractures.
Objectives:
Compartment syndrome (CS) after a tibial fracture in children is one of the orthopedic emergencies. Identifying high-risk patients in a timely fashion minimizes morbidities. This study aimed to find the risk factors of CS after a tibial fracture.
Methods:
The study data was retrieved from the Trauma Quality Improvement Program database of the calendar year 2017-2019. All patients aged <18 years old who were admitted to the hospital with tibial fractures were included in the study. Patients' characteristics, including demography, injury, injury severity, and associated crushed and vascular injuries were analyzed between the groups who developed CS versus those who did not develop CS after a tibial fracture. Multiple logistic regression analyses were performed to find the association of CS. All p values are two-sided and a p value<0.05 is considered statistically significant.
Results:
Of 4492 patients who qualified for the study, 49 (1.1%) patients developed CS. The patients who developed CS sustained more crush injuries and were associated with a higher rate of vascular injury (2% vs 0.1%, p=0.043% & 10.2% vs 2.2%, p=0.005). Multivariable analysis showed that for every increase in 1 year of age, the odds of occurrence of CS increased by 15.7% (adjusted OR (AOR)=1.157, 95% CI: 1.032 to 1.297, p=0.013). Non-African American race was associated with more than double the risk of developing CS when compared with the African American race, AOR was 2.238, (95% CI: (1.08 to 4.638)). The associated crush injury had an approximately 19-fold higher risk of CS when compared with patients presented with no crush injury, AOR was 18.812, (95% CI: (1.513 to 233.931)). Associated vascular injury was found to have significantly higher AOR, 3.509, 95% CI: (1.287 to 9.563) of CS.
Conclusion:
Increased age, non-African American race, vascular injury, and crushed injury were associated with a risk of developing CS after a tibial fracture.
Level Of Evidence Iv:
Study type: Observational cohort study.
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