Radiographic Predictors of Compartment Syndrome Occurring After Tibial Fracture

Objectives: Compartment syndrome (CS) is a potentially devastating injury associated with tibial fractures. Few data exist regarding radiographic indicators of CS. We hypothesized that radiographic signs are associated with development of CS. Design: Retrospective review. Setting: Level I trauma center. Patients: Consecutive series of adult patients with tibial fractures with (n = 56) and without (n = 922) CS. Intervention: None. Outcomes: AO/OTA fracture classification, Schatzker type, fracture length, fibular fracture, CS diagnosis. Results: The odds of CS increased by 1.67 per 10% increase in the ratio of fracture length to tibial length when considering all fractures. CS was most likely to occur with plateau fractures at 12% (shaft fractures, 3%; pilon fractures, 2%). Schatzker VI fractures were more likely to develop CS than any other Schatzker type. Fibular fracture was predictive of CS with plateau fractures only. Segmental fractures (AO/OTA type 42-C2) were not more likely to develop CS than other shaft fractures. Conclusions: Several objective and easily reproducible radiographic indicators should raise suspicion for CS. CS was more likely in plateau fractures, especially when fracture length was >20% of the tibial length, in the presence of fibular fracture, and classified as Schatzker VI. Conversely, segmental tibial shaft fractures were not more likely than other shaft fractures to develop CS.