Citation

Saiz AM, Wellman AC, Stwalley D, Wolinsky P, Miller AN. J. Orthop. Trauma 2019; ePub(ePub): ePub.

Affiliation

Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000001702

PMID

31738240

Abstract

INTRODUCTION: Tibia and forearm fractures are high-risk injuries for developing an acute compartment syndrome (ACS) with need for fasciotomy. The incidence of fasciotomies for these injuries varies widely in the literature, as do the risk factors. The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture.

METHODS: Data from the National Trauma Data Bank for the years 2004 - 2016 were analyzed and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy.

RESULTS: 1.22% of the forearm fractures and 3.79% of the tibia fractures had a fasciotomy. Patients with a fasciotomy were more likely to have invasive procedures (p < 0.0001); injuries resulting from machinery, motor vehicle collisions, and firearms (p < 0.0001); and smoke, use drugs and/or alcohol (p < 0.05) compared with patients that did not undergo fasciotomies. Facsiotomy procedures were associated with longer LOS and higher mortality rate (p < 0.05).

CONCLUSIONS: The incidence of a fasciotomy is less than 5% in tibia or forearm fractures. Patients who underwent fasciotomy have: higher energy injuries, increased alcohol or drug use, higher rates of surgical interventions, and increased LOS. Furthermore, having a fasciotomy is associated with increased mortality rate. When counseling patients and evaluating surgeon/hospital performance, fasciotomies can serve as an indicator and modifier for a more complex trauma pathology. LEVEL OF EVIDENCE: Level III, prognostic.

Language: en