Acute Compartment Syndrome in Adolescent Tibial Tubercle and Shaft Fractures

Pediatric tibial tubercle and tibial shaft fractures have traditionally been associated with high rates of acute compartment syndrome (ACS), with reported rates of up to 21% in tubercle fractures. However, the true rate of ACS in these fractures remains unclear, with wide variability among prior studies that challenges the necessity of routine admission or prophylactic fasciotomy. The goal of this study was to investigate the rates of ACS associated with tibial tubercle and shaft fractures in a large nationwide population of adolescents.

We conducted a retrospective analysis using the TriNetX Research Network database. We identified adolescent patients (ages 10-18) with isolated tibial tubercle or tibial shaft fractures between 2010 and 2024 using the International Classification of Diseases (ICD-10) codes. The primary outcomes were ACS diagnosis or fasciotomy within 180 days of fracture. We also collected information on patient demographics and comorbidities. Cox regression analysis was used to assess predictors of ACS, and Kaplan-Meier survival analysis was performed.

There were 2,440 and 32,802 patients in the tibial tubercle and shaft cohorts, respectively. The rate of ACS or fasciotomy was 0.7% (16/2,440) for tibial tubercle fractures and 0.3% (101/32,802) for tibial shaft fractures. Fasciotomy, regardless of ACS diagnosis, occurred in 0.6% and 0.1% of patients with tibial tubercle and shaft fractures, respectively. Male sex (HR: 3.01, 95% CI: 2.04-4.43, P < .001) and increasing age (HR: 1.21 per year, 95% CI: 1.17-1.24, P < .001) were significant risk factors for ACS, whereas obesity and the presence of multiple injuries were not.

In this population-level database study, both tibial tubercle and shaft fractures in adolescents were associated with low rates of ACS, which are lower than those reported in previous institutional reports. These findings suggest that admission, compartment pressure monitoring, and prophylactic fasciotomy should be considered on a case-by-case basis and not used as components of routine care. Nevertheless, it is important to emphasize that ACS remains a devastating complication that requires vigilance and a high degree of clinical suspicion.

(1)Adolescent tibial tubercle and shaft fractures have low rates of compartment syndrome.(2)Male sex and increased age are associated with an elevated compartment syndrome risk.(3)Admission and prophylactic fasciotomy should be considered on a case-by-case basis for most adolescents.

III, Retrospective Cohort Study.