BACKGROUND The purpose of this study was to evaluate the association between epidemiological, clinical and radiographic factors of patients with tibial shaft fractures and the occurrence of acute compartment syndrome. METHODS 270 consecutive adult patients sustaining 273 tibial shaft fractures between January 2005 and December 2009 were included in this retrospective cohort study. The outcome measure was acute compartment syndrome. Patient-related (age, sex), fracture-related (high- vs. low-energy injury, isolated trauma vs. polytrauma, closed vs. open fracture) and radiological parameters (AO/OTA classification, presence or absence of a noncontiguous tibial plateau or pilon fracture, distance from the centre of the tibial fracture to the talar dome, distance between tibial and fibular fracture if associated, and angulation, translation and over-riding of main tibial fragments) were evaluated regarding their potential association with acute compartment syndrome. Univariate analysis was performed and each covariate was adjusted for age and sex. Finally, a multivariable logistic regression model was built, and odds ratios and 95% confidence intervals were obtained. Statistical significance was defined as p < 0.05. RESULTS Acute compartment syndrome developed in 31 (11.4%) cases. In the multivariable regression model, four covariates remained statistically significantly associated with acute compartment syndrome: polytrauma, closed fracture, associated tibial plateau or pilon fracture and distance from the centre of the tibial fracture to the talar dome ≥15 cm. CONCLUSIONS One radiological parameter related to the occurrence of acute compartment syndrome has been highlighted in this study, namely a longer distance from the centre of the tibial fracture to the talar dome, meaning a more proximal fracture. This observation may be useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients). However, larger studies are mandatory to confirm and refine the prediction of acute compartment syndrome occurrence. Radiographic signs of significant displacement were not found to be correlated to acute compartment syndrome development. Finally, the higher rate of acute compartment syndrome occurring in tibial shaft fractures associated to other musculoskeletal, thoraco-abdominal or cranio-cerebral injuries must raise the level of suspicion of any surgeon managing multiply injured patients.

中文翻译：

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急性室综合征治疗胫骨干骨折的临床和影像学预测因素：一项回顾性队列研究。

背景技术这项研究的目的是评估胫骨干骨折患者的流行病学，临床和影像学因素与急性室综合征的发生之间的关系。方法这项回顾性队列研究纳入了2005年1月至2009年12月之间连续发生273例胫骨干骨折的270名成年患者。结果指标为急性室综合征。患者相关（年龄，性别），骨折相关（高能量与低能量损伤，孤立性创伤与多发伤，闭合性骨折与开放性骨折）和放射学参数（AO / OTA分类，是否存在不连续的胫骨）高原或pilon骨折，从胫骨骨折中心到距骨穹顶的距离，胫骨和腓骨骨折之间的距离（如果相关）以及成角度，对主要胫骨碎片的翻译和覆盖进行了评估，评估它们与急性区室综合征的潜在关联。进行单变量分析，并针对年龄和性别调整每个协变量。最后，建立了多变量逻辑回归模型，并获得了比值比和95％的置信区间。统计学显着性定义为p <0.05。结果急性房室综合征发生31例（11.4％）。在多变量回归模型中，四个协变量在统计学上仍与急性区室综合征显着相关：多发伤，闭合性骨折，相关的胫骨平台或pilon骨折以及从胫骨骨折中心到距骨穹顶的距离≥15cm。结论本研究强调了与急性室综合征的发生有关的一个放射学参数，即从胫骨骨折中心到距骨穹顶的距离更长，这意味着更近端的骨折。当难以评估临床表现时（临床体征可疑，患者不安，镇静或插管），这种观察可能会有用。但是，必须进行更大的研究才能确认和完善对急性室综合征的预测。没有发现显着移位的影像学征象与急性区室综合征的发展有关。最后，发生在与其他肌肉骨骼相关的胫骨干骨折中的急性室综合征的发生率较高，