Radiographic Predictors of Compartment Syndrome Occurring After Tibial Fracture.

Objectives: Compartment syndrome (CS) is a potentially devastating injury associated with tibial fractures. Few data exist regarding radiographic indicators of CS. We hypothesized that radiographic signs are associated with development of CS.

Design: Retrospective review.

Setting: Level I trauma center.

Patients: Consecutive series of adult patients with tibial fractures with (n = 56) and without (n = 922) CS.

Intervention: None.

Outcomes: AO/OTA fracture classification, Schatzker type, fracture length, fibular fracture, CS diagnosis.

Results: The odds of CS increased by 1.67 per 10% increase in the ratio of fracture length to tibial length when considering all fractures. CS was most likely to occur with plateau fractures at 12% (shaft fractures, 3%; pilon fractures, 2%). Schatzker VI fractures were more likely to develop CS than any other Schatzker type. Fibular fracture was predictive of CS with plateau fractures only. Segmental fractures (AO/OTA type 42-C2) were not more likely to develop CS than other shaft fractures.

Conclusions: Several objective and easily reproducible radiographic indicators should raise suspicion for CS. CS was more likely in plateau fractures, especially when fracture length was >20% of the tibial length, in the presence of fibular fracture, and classified as Schatzker VI. Conversely, segmental tibial shaft fractures were not more likely than other shaft fractures to develop CS.

Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.