title: Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome.
abstract: OBJECTIVE
  To analyze the rate of postoperative infection and nonunion after tibial fractures in patients treated for acute compartment syndrome (ACS) using (1) single-incision versus (2) dual-incision fasciotomy technique.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Review of all adult tibial fractures operatively treated (n = 2756) over a 12-year period identified 175 patients with concurrent ACS requiring fasciotomy. Of 60 patients treated with intramedullary nails, 36 patients had single-incision fasciotomy and 24 had dual-incision fasciotomy. Of 81 patients treated with plate fixation, 59 patients had single-incision fasciotomy and 22 had dual-incision fasciotomy.
  
  
  METHODS
  Tibial fixation with fasciotomy for ACS.
  
  
  METHODS
  Occurrence of postoperative infection and nonunion.
  
  
  RESULTS
  Both fasciotomy groups were similar across recorded patient and treatment characteristics. Need for skin graft was similar between fasciotomy groups. For patients treated with intramedullary nail (n = 60), 1 infection (2.8%) occurred in single-incision group versus 2 (8.3%) in dual-incision group (P = 0.558). Seven nonunions (19.4%) occurred in single-incision group versus 3 (12.5%) in dual-incision group (P = 0.726). For plate fixation patients (n = 81), 15 infections (25.4%) occurred with single-incision fasciotomy versus 5 infections (22.7%) with dual-incision fasciotomy (P = 1.000). Seven nonunions (11.9%) occurred with single-incision group versus 4 nonunions (18.2%) with dual-incision group (P = 0.479).
  
  
  CONCLUSIONS
  This is the first study to compare a single-incision fasciotomy technique to a dual-incision technique in the setting of tibial fractures with ACS, with similar infection and nonunion rates with either technique. The choice of fasciotomy technique can be based on surgeon experience or patient condition as opposed to a suspected elevated infection or nonunion risk with either technique.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, Vanderbilt University, Nashville, TN.
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.forename: D Jake
authors.initials: DJ
authors.lastname: McClure
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D003161:Compartment Syndromes / Q000209:etiology* / Q000601:surgery*; D000071938:Fasciotomy; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016038:Skin Transplantation; D013710:Tendons / Q000601:surgery; D013978:Tibial Fractures / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult