Medical Student Faculty of Medicine and Health Sciences, McGill University, United States
Background: Acute compartment syndrome(ACS) is a limb-threatening condition. While the association between fractures and ACS is well-established, the role of vascular injury in ACS development remains less understood. We investigated the incidence, risk factors, and outcomes of ACS, focusing on the impact of vascular injury in patients with lower leg fractures.
Methods: This retrospective study utilized data from 2017 of the Trauma Quality Programs data from the American College of Surgeons. From 997,970 trauma cases - 55,945 patients with lower leg fractures were identified, 1,410 of which had vascular injuries. Patient records were examined for demographic information and potential risk factors for compartment syndrome. A multiple logistic regression model was used to identify factors predictive of vascular injury as well as fasciotomy.
Outcome: The rate of fasciotomy treatment for ACS was 29.79% for patients with vascular injuries, compared to 3.83% in those without in our cohort of identified patients. Open fractures (OR =4.40, P < .0001), crush injuries (OR = 4.252, P < .0001), and dislocations (OR = 3.264, P < .0001) significantly increased the likelihood of vascular injury. Male sex (OR = 1.955, P < .0001) and higher BMI (OR = 1.020, P = 0.0030) were also associated with increased vascular injury risk. Among patients with vascular injuries, popliteal artery injury (OR = 3.626, P < .0001) and popliteal vein injury (OR = 2.273, P = 0.0032) were strong predictors of fasciotomy. Fractures of the upper end of the tibia also significantly increased the likelihood of fasciotomy in the context of vascular injury (OR = 1.663, P < .0001).
Conclusion: This study demonstrates a significantly higher incidence of ACS in lower leg fractures with vascular injury. However, the pathoanatomy of the fractures as well as the specific vessel injury may influence the level of risk for ACS.
