15,16 Patient history and clinical exams have been traditional methods for diagnosis of ACS, 17 though the measurement of compartment pressures through needle manometry made the diagnosis more definitive after 1975. 15 Signs and symptoms of tibial ACS vary but frequently involve skin or compartment tightness or both, unremitting pain, paresthesias, muscle weakness, and diminished or absent pulses. The majority of tibial ACS cases result from motor vehicle-related incidents in which victims are commonly the car driver or passenger or a pedestrian or bicyclist hit by the car sports-related injuries or falls from a height. Developmentally, the osseofascial compartments do not increase in size following skeletal maturity therefore, young men with relative muscle hypertrophy (compared with older patients with muscle atrophy) have less residual space for muscle expansion, which could potentially increase ACS risk. The majority of individuals participating in soccer and football are young, and in the 2012 study 100% of young adult patients (≥18 years old) who sustained a tibia fracture developed ACS. 12,13 A 2012 study 14 suggests the increased risk associated with young age may be activity based. 12 Risk factorsĪs noted, younger age may predispose patients to increased risk of ACS. 11 Because the frequency of ACS following tibial fractures is variable, dependable information that could be used in a prediction model to estimate ACS risk is highly sought and would likely include patient age, fracture location in the tibia (proximal, distal, metaphyseal, diaphyseal), and magnitude of comminution. These factors, therefore, should create suspicion of ACS when seen in clinical practice. In both case studies, male gender, young age, relatively high energy injury mechanism, bony deformity, and soft tissue injury likely contributed to an increased risk of ACS. Cross sectional diagram illustrates the compartments of the lower leg. 1-3,9 Most cases of ACS associated with tibial fractures occur in the diaphysis, though cases of ACS has resulted from a Salter Harris II distal tibia fracture caused by a skateboard accident in a boy aged 14 years 10 and from a pilon fracture in a man aged 19 years who was not wearing restraints during a motor vehicle collision. Prevalence of ACS following tibial fractures varies widely due to differing diagnostic techniques and patient samples, although young (<35 years of age) men seem to be at greatest risk. 6 Evidence suggests that fasciotomy should be performed when compartment syndrome is present, when there is suspicion that the compartment or compartments should be prophylactically treated, and when a lack of blood flow will permanently alter the patient’s condition. 4,5 Failure to diagnose the increased pressure within the closed anatomic space associated with ACS may lead to devastating consequences, including nerve injury, muscle necrosis, and loss of function. The elevated pressure causes a decrease in capillary blood flow due to a decrease in the pressure gradient at the microcirculation level. 1-3 Compartment syndrome occurs where there is excessive swelling within a closed fascia-bone space. The rates of ACS with tibia fractures ranges from 2% to 9%. Barfield, PhDĪcute compartment syndrome (ACS) is a potentially serious complication following a tibia fracture. Early diagnosis of increased compartmental pressure and timely surgical intervention can prevent adverse outcomes including nerve injury and muscle necrosis.īy Langdon A. Acute compartment syndrome can develop after open or closed tibial fractures, even those that appear to be benign.
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