Review Question - QID 219530

Young patient age has been found to be associated with the development of compartment syndrome in patients with tibial plateau fractures.

Tibial plateau fractures represent periarticular injuries of the proximal tibia that are often associated with significant soft tissue injuries. The associated rate of compartment syndrome ranges in the literature from 7-20%. Predictors of compartment syndrome in tibial plateau fractures include high-energy mechanism of injury, Schatzker VI class of fracture, fracture length, plateau-shaft combined fracture, presence of fibular fracture, and young patient age. Young patient age, in particular, has been associated with compartment syndrome in tibial plateau and tibial shaft fractures due to larger muscle mass and less fascial compliance, factors that tend to change with increasing age. The treatment involves early recognition and emergent fasciotomies to prevent permanent muscular and neurovascular compromise.

Deng et al. published on the predictors of acute compartment syndrome of the lower leg in adults following tibial plateau fractures. The authors reviewed 1119 consecutive patients with tibial plateau fractures who presented to a university-affiliated hospital with a level-I trauma center and found that 35 (3.1%) developed an acute compartment syndrome (ACS), of which only younger patient age and Schatzker VI type fracture were significantly associated with the development of ACS. They concluded that younger patient age and Schatzker VI type fracture were predictors of ACS of the lower leg in adults following tibial plateau fractures.

Marchand et al. reviewed the external validity of previously established predictors of compartment syndrome in tibial plateau fractures. The authors reviewed 513 patients with tibial plateau fractures treated operatively over a 10-year period and found that Schatzker VI fractures, high-energy mechanism, presence of a fibular fracture, fracture length, and plateau-shaft combined injury were all associated with the development of compartment syndrome. They concluded that the presence of each independent predictor had a cumulative effect such that when more than one variable is present, the chance of ACS increases, with patients having 3 and 4 predictive markers demonstrating a 20% and 27% chance of developing ACS, respectively.

Haller et al. reviewed whether or not early versus delayed spanning external fixator application impacted complication rates for high-energy tibial plateau and plafond injuries. The authors retrospectively reviewed 80 patients (42 plateaus) in the early external fixator cohort and 79 patients (45 plateaus) in the delayed cohort. They found that for compartment syndrome, there was no difference between early and delayed groups for plateau fractures. They concluded that they were unable to detect a difference in infection, compartment syndrome, secondary procedures, or length of hospitalization for patients who undergo early versus delayed external fixation for high-energy tibial plateau fractures.

Figures A and B are coronal and sagittal CT scan images, respectively, of a knee depicting a bicondylar tibial plateau fracture.

Incorrect Answers:
Answer 1: Arthritic progression in the short term would be unlikely and is more dependent in the long term on the degree of articular reduction with fixation.
Answers 3-5: The patient's age does not specifically increase his risk for arthrofibrosis in the setting of a bicondylar tibial plateau fracture, does not predict an increased risk of pin-site infection after external fixator application, and does not necessarily indicate the need for a gastrocnemius recession with definitive fixation in the absence of a contracture.