title: Infection and Nonunion After Fasciotomy for Compartment Syndrome Associated With Tibia Fractures: A Matched Cohort Comparison.
abstract: OBJECTIVE
  The objective was to compare the rates of union and infection in patients treated with and without fasciotomy for acute compartment syndrome (ACS) in operatively managed tibia fractures.
  
  
  METHODS
  This was a retrospective review.
  
  
  METHODS
  The study was conducted at both a Level 1 and Level II trauma center.
  
  
  METHODS
  Patients operated for tibial plateau fractures (group 1) and tibial shaft fractures (group 3) with ACS requiring fasciotomy were matched to patients without ACS (plateau: group 2, shaft: group 4) in a 1:3 ratio for age, sex, fracture pattern, and open/closed injury.
  
  
  METHODS
  Surgical treatment was provided with plates/screws (plateau fractures) or intramedullary rod (shaft fractures). Patients with ACS were treated with a 2-incision 4-compartment fasciotomy.
  
  
  METHODS
  Time to union and incidence of deep infection, nonunion, and delayed union.
  
  
  RESULTS
  One hundred eighty-four patients were included-group 1: 23 patients, group 2: 69 patients, group 3: 23 patients, and group 4: 69 patients. Time to union averaged 26.8 weeks for groups 1 and 3 and 21.5 weeks for groups 2 and 4 (P > 0.05). Nonunion occurred in 20% for groups 1 and 3 and in 5% for groups 2 and 4 (P = 0.003). Deep infection developed in 20% for groups 1 and 3 and in 4% for groups 2 and 4 (P = 0.001). There was a significant increase in infection in group 1 versus group 2 and nonunion in group 3 versus group 4. There were significantly more smokers for those with fasciotomies (46%) than without (20%, P < 0.001), though all statistical results remained similar after a binary regression analysis.
  
  
  CONCLUSIONS
  Four-compartment fasciotomies in patients with tibial shaft or plateau fractures is associated with a significant increase in infection and nonunion.
  
  
  METHODS
  Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX; †Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; ‡Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, FL; §Kaiser Permanente, Walnut Creek, CA; ‖Department of Orthopaedics and Traumatology, Ondokuz Mayis Üniversitesi, Samsun, Turkey; and ¶Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: James A
authors.initials: JA
authors.lastname: Blair
authors.forename: Thomas Kyle
authors.initials: TK
authors.lastname: Stoops
authors.forename: Michael C
authors.initials: MC
authors.lastname: Doarn
authors.forename: Dan
authors.initials: D
authors.lastname: Kemper
authors.forename: Murat
authors.initials: M
authors.lastname: Erdogan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Griffing
authors.forename: H Claude
authors.initials: HC
authors.lastname: Sagi
mesh_terms: D000328:Adult; D017677:Age Distribution; D000868:Anterior Compartment Syndrome / Q000209:etiology / Q000601:surgery*; D016022:Case-Control Studies; D000071938:Fasciotomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods; D005597:Fractures, Open / Q000150:complications / Q000473:pathology / Q000601:surgery; D005599:Fractures, Ununited / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology*; D013978:Tibial Fractures / Q000150:complications* / Q000473:pathology / Q000601:surgery*