Division of Trauma Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, 8091, Zurich, Switzerland.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):363-369. doi: 10.1007/s00590-023-03666-z. Epub 2023 Aug 3.
While lower extremity fractures are common injuries, concomitant compartment syndrome can lead to significant implications and surgical release (fasciotomy) is essential. The aim of this study was to identify potential predictors of compartment release and risk factors related to complications. Using a large nationwide cohort, this study compared patients suffering from lower extremity fractures with and without compartment syndrome during their primary in-hospital stay following trauma.
A retrospective analysis was conducted using the prospective surgical registry of the working group for quality assurance in surgery in Switzerland, which collects data from nearly 85% of all institutions involved in trauma surgery. Inclusion criteria Patients who underwent surgical treatment for tibia and/or fibula fractures between January 2012 and December 2022 were included in the study. Statistics Statistical analysis was performed using Chi-square, Fisher's exact test, and t test. Furthermore, a regression analysis was conducted to determine the independent risk factors for fasciotomy and related complications. In the present study, a p value less than 0.001 was determined to indicate statistical significance due to the large sample size.
The total number of cases analyzed was 1784, of which 98 underwent fasciotomies and 1686 did not undergo the procedure. Patients with fasciotomies were identified as significantly younger (39 vs. 43 years old) and mostly male (85% vs. 64%), with a significantly higher American Society of Anesthesiologists (ASA) score (ASA III 10% vs. 6%) and significantly more comorbidities (30% vs. 20%). These patients had significantly longer duration of surgeries (136 vs. 102 min). Furthermore, the total number of surgical interventions, the rate of antibiotic treatment, and related complications were significantly higher in the fasciotomy group. Sex, age, comorbidities, and fracture type (both bones fractured) were identified as relevant predictors for fasciotomy, while ASA class was the only predictor for in-hospital complications. Outcomes Patients who underwent fasciotomy had a significantly longer hospital stay (18 vs. 9 days) and a higher complication rate (42% vs. 6%) compared to those without fasciotomy. While fasciotomy may have played a role, other factors such as variations in patient characteristics and injury mechanisms may also contribute. Additionally, in-house mortality was found to be 0.17%, with no patient death recorded for the fasciotomy group.
Fasciotomy is vital. The knowledge about the further course is, however, helpful in resource allocation. We found significant differences between patients with and without fasciotomy in terms of age, sex, complication rate, length of stay, comorbidities, duration of operations, and use of antibiotics during their primary in-hospital stay. While the severity of the underlying trauma could not be modulated, awareness of the most relevant predictors for fasciotomy and related complications might help mitigate severe consequences and avoid adverse outcomes.
下肢骨折是常见损伤，但伴随的筋膜间室综合征可导致严重后果，需要进行外科减压（筋膜切开术）。本研究旨在确定筋膜切开术的潜在预测因素和相关并发症的危险因素。使用一个大型全国队列，本研究比较了创伤后首次住院期间患有下肢骨折伴或不伴筋膜间室综合征的患者。
使用瑞士外科质量保证工作组的前瞻性手术登记处进行回顾性分析，该登记处收集了几乎所有参与创伤外科的机构的近 85%的数据。纳入标准：2012 年 1 月至 2022 年 12 月期间接受胫骨和/或腓骨骨折手术治疗的患者纳入本研究。统计分析：使用卡方检验、Fisher 确切检验和 t 检验进行统计分析。此外，还进行了回归分析以确定筋膜切开术和相关并发症的独立危险因素。在本研究中，由于样本量大，p 值小于 0.001 被确定为具有统计学意义。
分析的总病例数为 1784 例，其中 98 例行筋膜切开术，1686 例未行该手术。行筋膜切开术的患者明显更年轻（39 岁 vs. 43 岁），且大多为男性（85% vs. 64%），美国麻醉医师协会（ASA）评分明显更高（ASA III 10% vs. 6%），合并症明显更多（30% vs. 20%）。这些患者的手术时间明显更长（136 分钟 vs. 102 分钟）。此外，筋膜切开术组的手术次数、抗生素治疗率和相关并发症明显更高。性别、年龄、合并症和骨折类型（均为双骨折）被确定为筋膜切开术的相关预测因素，而 ASA 分级是住院并发症的唯一预测因素。结局：行筋膜切开术的患者住院时间明显更长（18 天 vs. 9 天），并发症发生率明显更高（42% vs. 6%）。虽然筋膜切开术可能起了作用，但其他因素，如患者特征和损伤机制的变化，也可能起了作用。此外，院内死亡率为 0.17%，筋膜切开术组无患者死亡。
筋膜切开术至关重要。然而，了解进一步的病程有助于资源分配。我们发现，行筋膜切开术和不行筋膜切开术的患者在年龄、性别、并发症发生率、住院时间、合并症、手术时间和抗生素使用方面存在显著差异。虽然无法调节潜在创伤的严重程度，但了解筋膜切开术和相关并发症的最相关预测因素可能有助于减轻严重后果，避免不良结局。
