HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2025
Assessing the Rate and Risk Factors of Compartment Syndrome in Pediatric Tibial Tubercle Fractures.
СтатьяНазвание и аннотация: Перевод в очереди
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Youn Alex, Gifford Abbott, Swarup Ishaan
Аннотация
BACKGROUND: Acute compartment syndrome (ACS) is a limb-threatening complication of pediatric tibial tubercle fractures. Despite its severity, the incidence of ACS in pediatric cases has been largely unexplored.
PURPOSE: We sought to examine the incidence and risk factors of ACS and associated fasciotomies in pediatric patients with tibial tubercle fractures.
METHODS: We conducted a retrospective cohort study using data from the Pediatric Health Information System, a comprehensive inpatient and outpatient nationwide database. Inclusion criteria specified patients 18 years of age or younger with tibial tubercle fracture (International Classification of Disease, 10th Revision (ICD-10) diagnosis code, S82.151-156) between October 1, 2015, and June 30, 2023. Exclusion criteria were patients with a positive hematologic or immunologic flag and patients with a positive congenital or genetic defect flag. Patients with tibial tubercle fractures were stratified into 3 categories: (1) patients with a diagnosis code for ACS and/or a fasciotomy procedure code; (2) patients with a diagnosis code for ACS and a fasciotomy code; and (3) patients exclusively with a fasciotomy procedure code.
RESULTS: Of the 6830 included patients with tibial tubercle fractures, 4% had a code for ACS and/or fasciotomy, 1% had a code for ACS and a procedure code for fasciotomy, and 2.9% had a code for fasciotomy only. Univariate analysis revealed that older and male patients had higher rates of ACS and fasciotomies without any corresponding diagnosis of ACS, compared to their counterparts; White patients had higher rates of ACS than patients of other races. Multivariate analysis showed that age was the only significant predictor of ACS across all groups.
CONCLUSION: This retrospective database study suggests that ACS is a rare complication of pediatric tibial tubercle fractures and that fasciotomies without any evidence of ACS-interpreted as prophylactic fasciotomies-occur at a higher rate than formally diagnosed ACS.
LEVEL OF EVIDENCE: Level IV: Retrospective Cohort Study.
PURPOSE: We sought to examine the incidence and risk factors of ACS and associated fasciotomies in pediatric patients with tibial tubercle fractures.
METHODS: We conducted a retrospective cohort study using data from the Pediatric Health Information System, a comprehensive inpatient and outpatient nationwide database. Inclusion criteria specified patients 18 years of age or younger with tibial tubercle fracture (International Classification of Disease, 10th Revision (ICD-10) diagnosis code, S82.151-156) between October 1, 2015, and June 30, 2023. Exclusion criteria were patients with a positive hematologic or immunologic flag and patients with a positive congenital or genetic defect flag. Patients with tibial tubercle fractures were stratified into 3 categories: (1) patients with a diagnosis code for ACS and/or a fasciotomy procedure code; (2) patients with a diagnosis code for ACS and a fasciotomy code; and (3) patients exclusively with a fasciotomy procedure code.
RESULTS: Of the 6830 included patients with tibial tubercle fractures, 4% had a code for ACS and/or fasciotomy, 1% had a code for ACS and a procedure code for fasciotomy, and 2.9% had a code for fasciotomy only. Univariate analysis revealed that older and male patients had higher rates of ACS and fasciotomies without any corresponding diagnosis of ACS, compared to their counterparts; White patients had higher rates of ACS than patients of other races. Multivariate analysis showed that age was the only significant predictor of ACS across all groups.
CONCLUSION: This retrospective database study suggests that ACS is a rare complication of pediatric tibial tubercle fractures and that fasciotomies without any evidence of ACS-interpreted as prophylactic fasciotomies-occur at a higher rate than formally diagnosed ACS.
LEVEL OF EVIDENCE: Level IV: Retrospective Cohort Study.