Objective: To determine the correlation between the OTA classification of tibia fractures and the development of acute compartment syndrome (ACS).

Design: Retrospective review of prospectively collected database

Setting: Single level 1 academic trauma center

Patients: All patients with a tibia fracture from 2006 to 2016. 3606 fractures were initially identified. Skeletally mature patients with plate or intramedullary fixation managed from initial injury through definitive fixation at our institution were included, leaving 2885 fractures in 2778 patients.

Methods: After database and chart review, univariate analyses were conducted using independent t-tests for continuous data and chi-square tests of independence for categorical data. A simultaneous multivariate binary logistic regression was developed to identify variables significantly associated with ACS.

Results: Average age was 42.9 +/- 18.0 years. 823 (28.5%) fractures were open. 565 (19.6%) fractures underwent initial external fixation. 952 (33.0%) fractures involved the proximal (OTA 41), 1262 (43.7%) involved the middle (OTA 42), and 834 (28.9%) involved the distal segment (OTA 43). 1696 fractures (58.8%) underwent plating, 1118 fractures (38.8%) underwent intramedullary fixation, and 71 (2.4%) underwent a combination.

ACS occurred in 136 limbs (4.7%). The average age was 36.2 years versus 43.3 years in those without (p<0.001). Males were 1.7 times more likely to progress to ACS than females (p=0.012). Patients who underwent external fixation were 1.9 times more likely to develop ACS (p=0.003). OTA 43 injuries were at least 4.0 times less likely to foster ACS versus OTA 41 or 42 injuries (p=<0.007). OTA 41-C injuries were 5.5 times more likely to advance to ACS compared to OTA 41-A(p=0.03) There was a significantly higher rate of ACS in OTA 42-B (p=0.005) and OTA 42-C (p=0.002) fractures when compared to OTA 42-A fractures. In the distal segment, fracture type did not predict the risk of ACS(p>0.15). Group 1 fractures had a lower rate of ACS compared to group 2 (p=0.03) and group 3 (p=0.003) fractures in the middle segment only. Bilateral tibia fractures had a 2.7 times lower rate of ACS (p=0.04).

Open injury, multiple segment injury, fixation type, and concurrent pelvic or femoral fractures did not predict ACS.

Conclusions: In this large cohort of tibia fractures we found that the age, sex, and OTA classification were highly predictive for the development of ACS.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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