The Prevalence of Acute Compartment Syndrome in Pediatric Tibial Tubercle Fractures.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-11-01 Epub Date: 2024-07-18 DOI:10.1097/BPO.0000000000002776

Victor H Martinez, Natalia Pluta, Joshua C Tadlock, Daniel J Cognetti

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Abstract

Objective: Tibial tubercle fractures are a unique class of pediatric orthopaedic injuries that frequently necessitate surgical treatment and strict monitoring due to the associated risk of acute compartment syndrome (ACS). However, current literature is conspicuously limited in its ability to estimate the risk of ACS after these fractures. Therefore, the purpose of this study is to utilize a nationwide database to estimate the prevalence of ACS after pediatric tibial tubercle fractures.

Methods: We utilized the Healthcare Cost and Utilization Project's Kids' Inpatient Database (2019) to identify all pediatric patients, 18 years of age and under, with isolated tibial tubercle fractures (International Classification of Diseases, 10th revision Clinical Modification S82.151-S82.156) and ACS (T79.A0, T79.A2, T79.A29). Patients were excluded if they had additional lower extremity injuries (ie, tibial shaft, plateau, etc). A subanalysis was conducted for those undergoing fasciotomy, with and without an ACS diagnosis.

Results: Among the 591 isolated tibial tubercle fractures, there were 8 ACS cases for a prevalence of 1.35%. There were 22 (3.72%) additional cases of fasciotomy without an ACS diagnosis. All ACS cases were diagnosed during the original hospitalization; all were male and had closed fractures. The cohort included 469 teenagers (13+ years) and 77 pre-teens, with 40 females and 506 males. Racial demographics: 132 white, 232 black, 112 Hispanic, 15 Asian, 4 Native American, 23 unknown, and 28 others. No significant associations were found between ACS and age, race, insurance status, mechanism of injury, or hospital region.

Conclusion: The rate of ACS in pediatric tibial tubercle fractures appears to be much lower than previously reported, at 1.35%. However, the nearly three-fold higher prevalence of fasciotomy without an ACS diagnosis, suggests a generous use of prophylactic fasciotomies and/or an undercharacterization of actual ACS cases from miscoding. This is the first and largest study to employ a nationally representative database to investigate the prevalence of ACS after tibial tubercle fractures.

Level of evidence: Level III.

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小儿胫骨结节骨折中急性室间隔综合征的发病率。

目的：胫骨结节骨折是一类独特的小儿骨科损伤，由于存在急性室间隔综合征（ACS）的相关风险，因此经常需要进行手术治疗和严格监测。然而，目前的文献在估计此类骨折后发生 ACS 的风险方面存在明显的局限性。因此，本研究的目的是利用一个全国性数据库来估算小儿胫骨结节骨折后ACS的发病率：我们利用医疗保健成本与利用项目的儿童住院患者数据库（2019 年）来识别所有 18 岁及以下、患有孤立性胫骨结节骨折（国际疾病分类第 10 版临床修订版 S82.151-S82.156）和 ACS（T79.A0、T79.A2、T79.A29）的儿童患者。如果患者有其他下肢损伤（如胫骨轴、平台等），则将其排除在外。对接受筋膜切开术的患者进行了子分析，包括有无 ACS 诊断：在 591 例孤立性胫骨结节骨折中，有 8 例 ACS 病例，发病率为 1.35%。另有 22 例（3.72%）筋膜切开术病例未确诊为 ACS。所有 ACS 病例均在最初住院期间确诊；所有病例均为男性，骨折为闭合性骨折。队列中包括 469 名青少年（13 岁以上）和 77 名学龄前儿童，其中女性 40 名，男性 506 名。种族人口统计学特征：132 名白人、232 名黑人、112 名西班牙裔、15 名亚裔、4 名美国原住民、23 名未知种族和 28 名其他种族。ACS与年龄、种族、保险状况、受伤机制或医院所在区域均无明显关联：结论：小儿胫骨结节骨折的 ACS 发生率似乎比之前报道的 1.35% 低得多。然而，在未确诊ACS的情况下进行筋膜切开术的比例高出近三倍，这表明预防性筋膜切开术的使用率较高，以及/或因编码错误导致实际ACS病例的定性不足。这是首次采用具有全国代表性的数据库来调查胫骨结节骨折后ACS患病率的最大规模研究：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.