Skip to main content

Advertisement

Log in

Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation

A retrospective analysis of 15 cases

Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good.

Materials and Methods

Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system.

Results

At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed.

Conclusions

Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sood LK, Kanojia R, Vijay K, Mehra A, Sud A, Guglani A. Compartment syndrome-Early diagnosis and treatment. Indian J Orthop 2001;35:177–9.

    Google Scholar 

  2. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res 1979;138 94–104.

    Google Scholar 

  3. Schatzker J, Tile M. The Rational of Operative Fracture Care. 2nd ed. Berlin: Springer Verlag; 1996. p. 420–38.

    Book  Google Scholar 

  4. Watson JT. High-energy fractures of the tibial plateau. Orthop Clin North Am 1994;25:723–52.

    CAS  PubMed  Google Scholar 

  5. Yang EC, Weiner L, Strauss E, Sedlin E, Kelley M, Raphael J. Metaphyseal dissociation fractures of the proximal tibia. An analysis of treatment and complications. Am J Orthop (Belle Mead NJ) 1995;24:695–704.

    CAS  Google Scholar 

  6. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 2005;439:207–14.

    Article  CAS  PubMed  Google Scholar 

  7. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am 1976;58:453–8.

    Article  CAS  PubMed  Google Scholar 

  8. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007;21 10 Suppl: S1–133.

    Article  CAS  PubMed  Google Scholar 

  9. Martin JS, Marsh JL. Current classification of fractures. Rationale and utility. Radiol Clin North Am 1997;35:491–506.

    CAS  PubMed  Google Scholar 

  10. Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007;89:1010–4.

    Article  CAS  PubMed  Google Scholar 

  11. Musahl V, Tarkin I, Kobbe P, Tzioupis C, Siska PA, Pape HC. New trends and techniques in open reduction and internal fixation of fractures of the tibial plateau. J Bone Joint Surg Br 2009;91:426–33.

    Article  CAS  PubMed  Google Scholar 

  12. Hayakawa H, Aldington DJ, Moore RA. Acute traumatic compartment syndrome: A systematic review of results of fasciotomy. Trauma 2009;11:5–35.

    Article  Google Scholar 

  13. Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res 2010;468:940–50.

    Article  PubMed  Google Scholar 

  14. Lundy DW, Albert MJ. Pearls and pitfalls in the treatment of tibial plateau fractures. Am Assoc Orthop Surg 2007;1:21.

    Google Scholar 

  15. Honkonen SE. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 1995;9:273–7.

    Article  CAS  PubMed  Google Scholar 

  16. Whitehouse SL, Blom AW, Taylor AH, Pattison GT, Bannister GC. The Oxford Knee Score; problems and pitfalls. Knee 2005;12:287–91.

    Article  PubMed  Google Scholar 

  17. Lachiewicz PF, Funcik T. Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop Relat Res 1990;259:210–5.

    Google Scholar 

  18. Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002;84-A:1541–51.

    Article  Google Scholar 

  19. Azar FM. Traumatic disorders. In: Terry Canale S, Beaty JH, editors. Campbell’s Operative Orthopaedics. 12th ed. Philadelphia, PA, USA Elsevier; 2013. p. 2311–6.

    Chapter  Google Scholar 

  20. Gunasekaran Kumar, Nicholas Peterson, Badri Narayan, Bicondylar tibial fractures: Internal or external fixation? Indian journal of orthopaedics. 2011;45:116–24.

    Article  Google Scholar 

  21. Prasad GT, Kumar TS, Kumar RK, Murthy GK, Sundaram N, Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates, Indian journal oforthopaedics. 2013;47:188–94.

    Article  Google Scholar 

  22. Stark El, Stucken C, Trainer G, Tornetta P 3rd. Compartment syndrome in Schatzker type VI plateau fractures and medial condylar fracture-dislocations treated with temporary external fixation. J Orthop Trauma 2009;23:502–6.

    Article  PubMed  Google Scholar 

  23. Egol KAI, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): The results of a prospective, standardized protocol. J Orthop Trauma 2005;19:448–55; discussion 456.

    Article  PubMed  Google Scholar 

  24. M Thimmegowda, SR Kurpad, Kamini Kurpad, K Srinivasan, Management and follow up of tibial plateau fractures by T clamp external fixator and limited internal fixation. Indian J Orthop 2005;39:163–65.

    Article  Google Scholar 

  25. Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 2006;88:2613–23.

    Article  Google Scholar 

  26. Yong Zhang, De-gang Fan, Bao-an Ma, Si-guo Sun.Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique. Orthopedics. March 2012;35:359–64.

    Google Scholar 

  27. Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF. A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures [published online ahead of print January 24, 2008]. Knee 2008;15:139–143. doi: 10.1016/j.knee. 2007.12.001.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Naveen Sharma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, N., Singh, V., Agrawal, A. et al. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation. IJOO 49, 502–509 (2015). https://doi.org/10.4103/0019-5413.164044

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.164044

Key words

MeSH terms

Navigation