Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd, Route 0165, Galveston, TX 77555, United States.
School of Medicine, The University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555, United States.
Injury. 2021 Jun;52(6):1621-1624. doi: 10.1016/j.injury.2021.01.002. Epub 2021 Jan 7.
Acute compartment syndrome (CS) is a common complication of tibia shaft fractures (TSFs), and occurs when the pressure inside a myofascial compartment rises and impairs tissue perfusion. If treatment is delayed due to a missed diagnosis, amputation or permanent loss of function can result. This study aims to determine the incidence, clinical associations, and risk factors for missed CS following surgical stabilization of tibia shaft fractures (TSFs) using data from the National Trauma Data Bank (NTDB).
NTDB data files from 2007 to 2016 were accessed to collect information on patients undergoing surgical fixation of TSFs. Patients with an Injury Severity Score (ISS) > 15 or inferred Gustilo-Anderson IIIB/IIIC fractures were excluded to create a more homogenous sample of lower-grade TSFs. Compartment syndrome that was originally missed leading to late intervention was the main outcome under investigation. Bivariate tests were used to assess the relationships between missed CS and the preoperative variables. If a variable and a complication had an association with a P ≤ 0.2, it was included in a multivariate logistic regression model.
A total of 184,612 patients met our inclusion criteria, and 1,269 patients (0.76%) had a missed CS diagnosis. Bivariate analysis demonstrated that male gender had a significant positive association with a missed CS diagnosis, while older age had a significant negative association (odds ratio [OR] = 2.17, 0.99; P < 0.001). Multivariate analysis revealed that male gender was the most significant independent risk factor for a missed diagnosis of compartment syndrome (OR = 1.84, P < 0.00001), followed by alcoholism, penetrating trauma, and smoking (OR = 1.51, 1.46, 1.43; P < 0.02). The only significant protective factor was open fracture (OR = 0.70, P < 0.0001).
Our research identified several significant risk factors for missed CS after TSF, as well as positive and negative associations. Male gender, age, and lifestyle choices such as alcohol use and smoking conferred increased risks. These variables may assist physicians in identifying at-risk patients who may benefit from increased monitoring, and potentially prevent the high morbidity associated with this condition.
急性间隔综合征（CS）是胫骨骨干骨折（TSF）的常见并发症，当筋膜间隔内的压力升高并损害组织灌注时发生。如果由于漏诊而延迟治疗，则可能导致截肢或永久性功能丧失。本研究旨在使用国家创伤数据库（NTDB）的数据，确定使用手术稳定胫骨骨干骨折（TSF）后 CS 漏诊的发生率、临床相关性和危险因素。
访问 NTDB 数据文件，以收集 2007 年至 2016 年接受 TSF 手术固定的患者信息。排除损伤严重程度评分（ISS）> 15 或推断的 Gustilo-Anderson IIIB/IIIC 骨折的患者，以创建更同质的低等级 TSF 样本。最初漏诊导致晚期干预的间隔综合征是主要调查结果。使用双变量检验评估 CS 漏诊与术前变量之间的关系。如果变量和并发症与 P≤0.2 有联系，则将其纳入多变量逻辑回归模型。
共有 184612 名患者符合纳入标准，其中 1269 名（0.76%）患者出现 CS 漏诊诊断。双变量分析表明，男性性别与 CS 漏诊诊断有显著正相关，而年龄较大与 CS 漏诊诊断有显著负相关（比值比[OR] 2.17，0.99；P < 0.001）。多变量分析显示，男性是 CS 漏诊的最显著独立危险因素（OR 1.84，P < 0.00001），其次是酗酒、穿透性创伤和吸烟（OR 1.51，1.46，1.43；P < 0.02）。唯一显著的保护因素是开放性骨折（OR 0.70，P < 0.0001）。
我们的研究确定了 TSF 后 CS 漏诊的几个显著危险因素，以及阳性和阴性关联。男性、年龄以及饮酒和吸烟等生活方式选择增加了风险。这些变量可以帮助医生识别处于高风险的患者，他们可能受益于增加监测，并有可能预防与该疾病相关的高发病率。
