Assessing the Rate and Risk Factors of Compartment Syndrome in Pediatric Tibial Tubercle Fractures.

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.