Acute compartment syndrome in patients with tibia fractures transferred for definitive fracture care.

Overview

We sought to determine if patients evaluated at an outside institution for a tibia fracture and transferred to a referral hospital for fracture management were at risk for having acute compartment syndrome (ACS) on arrival. We conducted a database search for cases in which patients were referred for definitive fixation of tibia fractures, and on initial evaluation at our institution were diagnosed with ACS that necessitated fasciotomy. Incidence, demographics, fracture type, early complications, and factors that predict ACS were evaluated. Between 1996 and 2008, 9 patients (6 men, 3 women; mean age, 44.4 years) were transferred for definitive fixation of a tibia fracture and on presentation had ACS of the involved extremity (1.0% of all tibia fractures treated during this period). Two of the 9 patients developed contractures. Seven of the 9 patients had a good clinical result, and there were no amputations. There is increased risk for ACS in all patients with musculoskeletal trauma, irrespective of age, sex, fracture type, or injury mechanism. Given this risk, physicians must closely monitor patients. A patient should not be transferred until a fasciotomy is performed, if there is a significant risk of developing compartment syndrome prior to or during transport.