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Risk of Acute Compartment Syndrome in Pediatric Patients With Tibial Tubercle Avulsion Fractures: A Retrospective
Michael A Bergen1, Emil Stefan Vutescu, Samuel McKinnon
1Department of Orthopaedic Surgery, The Warren Alpert Medical School, Brown University, Providence, RI.
Insights
Tibial tubercle avulsion fractures (TTAFs) in children rarely lead to acute compartment syndrome (ACS). This study found no ACS cases, suggesting same-day discharge may be safe for low-risk pediatric patients after TTAF diagnosis or surgery.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Sports Medicine
Background:
- Tibial tubercle avulsion fractures (TTAFs) are uncommon pediatric physeal injuries.
- There is a perceived risk of acute compartment syndrome (ACS) associated with TTAFs, often leading to prolonged hospital stays for monitoring and prophylactic fasciotomy.
Purpose of the Study:
- To evaluate the incidence of ACS in pediatric patients with TTAFs at a single institution.
- To assess the safety and necessity of prolonged hospital admission and prophylactic fasciotomy for TTAFs.
Main Methods:
- Retrospective review of pediatric patients (8-18 years) with TTAFs from 2017-2023.
- Analysis of patient demographics, injury mechanisms, fracture types (Ogden classification), and clinical outcomes.
- ACS diagnosis based on clinical examination or need for therapeutic fasciotomy.
Main Results:
- 49 TTAFs in 47 pediatric patients were analyzed.
- No cases of acute compartment syndrome (ACS) were observed during the post-injury or postoperative period.
- Most patients (69%) were admitted overnight, and 96% underwent surgical fixation, but no ACS complications occurred.
Conclusions:
- The risk of ACS in pediatric patients with TTAF appears to be low.
- Same-day discharge may be a safe option for select low-risk pediatric patients following TTAF diagnosis or surgical management, guided by clinical judgment.
Objective:
Tibial tubercle avulsion fractures (TTAFs) represent 0.4% to 2.7% of pediatric physeal injuries. These injuries are thought to confer a risk of acute compartment syndrome (ACS), and these patients are often admitted for compartment monitoring and, in many cases, undergo prophylactic fasciotomy. This study sought to review our institution's experience with TTAF and associated compartment syndrome in pediatric patients.
Methods:
All patients aged 8 to 18 years with TTAF at our institution from January 1, 2017 to January 1, 2023 were retrospectively reviewed. Patient demographics, injury mechanism, fracture morphology, and postinjury course were reviewed. ACS was diagnosed by clinical exam or necessitating therapeutic compartment fasciotomy.
Results:
A total of 49 TTAFs in 47 patients were included in the final analysis. The mean age was 14.5 ± 1.2 years (range: 11 to 17), and males were significantly older than females (14.6 ± 1.1 vs 13.3 ± 1.3 y, P = 0.01). The average body mass index was 27.1 ± 7.0, and males had a significantly lower body mass index than females (26.3 ± 6.5 vs 34.1 ± 8.5, P = 0.03). Basketball was the most common mechanism of injury (49%), followed by soccer (13%), football (11%), trampoline (6%), fall (6%), jumping (4%), lacrosse (4%), running (4%), and softball (2%). The Ogden fracture types were as follows: I: 10%; II: 16%; III: 41%; IV: 24%; V: 8%. Thirty-four patients (69%) were admitted to the hospital for at least one night after presentation. Forty-six (96%) underwent surgical fixation an average of 3.5 days after injury. No patients developed ACS during their post-injury or postoperative course. Three patients underwent the removal of hardware. No other complications were observed. The average follow-up duration was 238 days.
Conclusions:
The results of this study suggest that the risk of ACS in pediatric patients with TTAF may be small enough to allow for same-day discharge after diagnosis or operative management in patients deemed to be sufficiently low risk by clinical judgment.
Level Of Evidence:
Level III-retrospective comparative study.
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