Objective: Bicondylar tibial plateau fracture with metaphyseal-diaphyseal dissociation. Schatzker VI and medial plateau fracture-dislocations are commonly treated with initial external fixation until the soft tissues allow for more definitive internal fixation. The purpose of this study was to review the incidence of compartment syndrome (CS) in these injuries and the timing of their occurrence in relation to placement of the external fixator.
Design: Retrospective cohort, consecutive series.
Setting: Academic level I trauma center.
Patients/participants: Over a 5-year period, 67 patients with tibial plateau fractures and fracture-dislocations were treated with initial external fixation within 48 hours of injury. There were 50 fractures (type VI) and 17 fracture-dislocations.
Intervention: CS was documented prospectively, and all patients were examined for signs of missed CS during office visits.
Main Outcome Measure: The timing of the CS was noted as present at presentation and diagnosis after external fixation but during the initial operative session, late, or missed.
Results: Overall, there were 18 CSs (27%) in 67 extremities. CS was more common after fracture-dislocations (9 of 17) than plateau fractures (9 of 50) (P = 0.009, chi). Most CSs were diagnosed after frame placement (10), either in the operating room at the initial session (4 of 10) or within the first 48 hours after frame placement (3 of 10). There were 3 delayed cases diagnosed after the CS had run its course. All 3 of these patients had external fixators that included the foot in the neutral position.
Conclusion: The incidence of CS for Schatzker type VI (18%) and medial plateau fracture-dislocations (53%) is high. When compared with the Schatzker type VI injuries, our data suggest that medial plateau fracture-dislocations may be at increased risk of developing CS after placement of spanning external fixation. We recommend careful monitoring of Schatzker type VI fractures and especially medial plateau fracture-dislocations after placement of spanning external fixators.
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