Incidence and risk factors for acute compartment syndrome in pediatric tibia fractures

Acute compartment syndrome (ACS) is a rare complication following traumatic injuries in pediatric patients, and tibia fractures represent the most common cause of ACS. To determine the incidence and risk factors of developing ACS, State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, were used to retrospectively identify patients 1-18 years of age with tibia fractures from 2006 to 2015 (quarter 3). The HCUP Nationwide Emergency Department Sample for nationwide data was also queried. Multivariable generalized estimating equations models were used to determine risk factors associated with development of ACS. A total of 50 640 patients with tibia fractures were studied, and 309 cases of ACS were identified. The incidence of ACS was 0.6 and 5.5% in the all tibia and open tibia fracture groups, respectively. Twenty-three cases of ACS (7.4% of all ACS) were diagnosed after discharge from the index admission, which was more common in teens treated nonoperatively. Predictors of increased ACS risk in the all tibia fracture group included age 13-18 [relative risk (RR): 4.04)], open fractures (RR: 3.83), and motor vehicle crash (MVC) mechanism (RR: 5.69). Nationwide, open and operatively treated fractures had an increased ACS rate (3.98 and 5.51%, respectively). Teenagers, open fractures, and MVC mechanisms were most strongly associated with ACS. ACS can present in a delayed fashion, as evidenced by postindex cases.