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The Prevalence of Acute Compartment Syndrome in Pediatric Tibial Tubercle Fractures
Victor H Martinez1, Natalia Pluta2, Joshua C Tadlock3
1Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio.
Insights
Acute compartment syndrome (ACS) risk in pediatric tibial tubercle fractures is 1.35%, lower than previously thought. This study highlights potential overuse of prophylactic fasciotomies in pediatric fracture care.
Area of Science:
- Pediatric Orthopaedics
- Trauma Surgery
- Epidemiology
Background:
- Tibial tubercle fractures in children are associated with a risk of acute compartment syndrome (ACS).
- Existing literature lacks robust data for estimating ACS prevalence after these specific pediatric fractures.
- Surgical intervention and close monitoring are often required due to ACS risks.
Purpose of the Study:
- To determine the prevalence of acute compartment syndrome (ACS) in pediatric patients with tibial tubercle fractures.
- To utilize a nationwide inpatient database for a comprehensive epidemiological analysis.
- To provide updated risk data for managing pediatric tibial tubercle fractures.
Main Methods:
- Analysis of the 2019 Healthcare Cost and Utilization Project's Kids' Inpatient Database.
- Identification of pediatric patients (≤18 years) with isolated tibial tubercle fractures and ACS diagnoses.
- Exclusion of patients with other lower extremity injuries; subanalysis of fasciotomy cases.
Main Results:
- A prevalence of 1.35% for ACS was observed among 591 isolated tibial tubercle fractures.
- Fasciotomy without an ACS diagnosis occurred in 3.72% of cases, suggesting potential prophylactic use or miscoding.
- ACS cases were predominantly in males with closed fractures; no significant associations with age, race, or injury mechanism were found.
Conclusions:
- The incidence of ACS following pediatric tibial tubercle fractures is lower than previously estimated (1.35%).
- A higher rate of fasciotomy without ACS diagnosis indicates possible overuse of prophylactic procedures or underdiagnosis.
- This study provides the largest national estimate of ACS prevalence in this pediatric fracture cohort.
Objective:
Tibial tubercle fractures are a unique class of pediatric orthopaedic injuries that frequently necessitate surgical treatment and strict monitoring due to the associated risk of acute compartment syndrome (ACS). However, current literature is conspicuously limited in its ability to estimate the risk of ACS after these fractures. Therefore, the purpose of this study is to utilize a nationwide database to estimate the prevalence of ACS after pediatric tibial tubercle fractures.
Methods:
We utilized the Healthcare Cost and Utilization Project's Kids' Inpatient Database (2019) to identify all pediatric patients, 18 years of age and under, with isolated tibial tubercle fractures (International Classification of Diseases, 10th revision Clinical Modification S82.151-S82.156) and ACS (T79.A0, T79.A2, T79.A29). Patients were excluded if they had additional lower extremity injuries (ie, tibial shaft, plateau, etc). A subanalysis was conducted for those undergoing fasciotomy, with and without an ACS diagnosis.
Results:
Among the 591 isolated tibial tubercle fractures, there were 8 ACS cases for a prevalence of 1.35%. There were 22 (3.72%) additional cases of fasciotomy without an ACS diagnosis. All ACS cases were diagnosed during the original hospitalization; all were male and had closed fractures. The cohort included 469 teenagers (13+ years) and 77 pre-teens, with 40 females and 506 males. Racial demographics: 132 white, 232 black, 112 Hispanic, 15 Asian, 4 Native American, 23 unknown, and 28 others. No significant associations were found between ACS and age, race, insurance status, mechanism of injury, or hospital region.
Conclusion:
The rate of ACS in pediatric tibial tubercle fractures appears to be much lower than previously reported, at 1.35%. However, the nearly three-fold higher prevalence of fasciotomy without an ACS diagnosis, suggests a generous use of prophylactic fasciotomies and/or an undercharacterization of actual ACS cases from miscoding. This is the first and largest study to employ a nationally representative database to investigate the prevalence of ACS after tibial tubercle fractures.
Level Of Evidence:
Level III.
