Sharri J Mortensen1,2, Sebastian Orman3,2, Joseph Serino4,2, Amin Mohamadi1, Ara Nazarian1,5,6,7, Arvind von Keudell8,5,7. 1. Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 2. These authors have contributed equally as first authors. 3. Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA. 4. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA. 5. Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA. 6. Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia. 7. These authors have contributed equally as senior authors. 8. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Acute compartment syndrome (ACS) is a devastating condition, further aggravated by delayed diagnosis. Since ACS is a clinical diagnosis, identification of risk factors for individual patients may help with earlier detection. This study aims to identify the risk factors associated with the development of ACS of the extremities. METHODS: We performed a systematic review and meta-analysis of studies with adult patients at risk for and with traumatic ACS of the extremity. Non-traumatic, chronic exertional, vascular and abdominal compartment syndrome were excluded. Technical reports, biomechanical studies, abstracts, studies of non-human subjects, non-English studies, and studies with less than five subjects were excluded. Meta-analysis was performed on a subset of studies including a control group. We addressed cases of substantial heterogeneity among the studies with subgroup analysis, and whenever heterogeneity remained significant, we employed random effect meta-analysis for the data pooling. The study protocol has been registered in PROSPERO (ID = CRD42019126603). RESULTS: There were 19 studies with 48,887 patients investigating risk factors of traumatic ACS. Of these, there were 1,716 patients with the diagnosis of traumatic ACS. Fourteen studies (46,300 controls and 1,358 ACS patients) qualified for meta-analysis. Male to female ratio was 5.5 with an average age of 36 years. Factors that were significantly associated with the development of ACS were: age 18-64 (OR: 1.34, 95% CI: 1.07-1.68), male (OR: 2.18, 95% CI: 1.53-3.10), gunshot wound with fracture and vascular injury (OR: 12.5, 95% CI: 5.69-27.46), combined forefoot and midfoot injury (OR: 3.3, 95% CI: 2.39-4.57), injury severity score (ISS) 0-9 (OR: 1.58, 95% CI: 1.27-1.97), OTA/AO type C fractures (OR: 2.75, 95% CI: 1.04-7.28), vascular injury (OR: 9.05, 95% CI: 6.69-12.26), and high-energy trauma (OR: 3.10, 95% CI: 1.60-5.82). Factors such as tibia fracture and crush injury were reported but were not included in quantitative analysis, due to lack of control groups and/or only one study qualifying for meta-analysis. CONCLUSION: This study reports on the current significant risk factors for developing traumatic ACS. The most common risk factors included age, sex, gunshot wound with a vascular injury, OTA/AO fracture type C and high-energy trauma.
BACKGROUND: Acute compartment syndrome (ACS) is a devastating condition, further aggravated by delayed diagnosis. Since ACS is a clinical diagnosis, identification of risk factors for individual patients may help with earlier detection. This study aims to identify the risk factors associated with the development of ACS of the extremities. METHODS: We performed a systematic review and meta-analysis of studies with adult patients at risk for and with traumatic ACS of the extremity. Non-traumatic, chronic exertional, vascular and abdominal compartment syndrome were excluded. Technical reports, biomechanical studies, abstracts, studies of non-human subjects, non-English studies, and studies with less than five subjects were excluded. Meta-analysis was performed on a subset of studies including a control group. We addressed cases of substantial heterogeneity among the studies with subgroup analysis, and whenever heterogeneity remained significant, we employed random effect meta-analysis for the data pooling. The study protocol has been registered in PROSPERO (ID = CRD42019126603). RESULTS: There were 19 studies with 48,887 patients investigating risk factors of traumatic ACS. Of these, there were 1,716 patients with the diagnosis of traumatic ACS. Fourteen studies (46,300 controls and 1,358 ACS patients) qualified for meta-analysis. Male to female ratio was 5.5 with an average age of 36 years. Factors that were significantly associated with the development of ACS were: age 18-64 (OR: 1.34, 95% CI: 1.07-1.68), male (OR: 2.18, 95% CI: 1.53-3.10), gunshot wound with fracture and vascular injury (OR: 12.5, 95% CI: 5.69-27.46), combined forefoot and midfoot injury (OR: 3.3, 95% CI: 2.39-4.57), injury severity score (ISS) 0-9 (OR: 1.58, 95% CI: 1.27-1.97), OTA/AO type C fractures (OR: 2.75, 95% CI: 1.04-7.28), vascular injury (OR: 9.05, 95% CI: 6.69-12.26), and high-energy trauma (OR: 3.10, 95% CI: 1.60-5.82). Factors such as tibia fracture and crush injury were reported but were not included in quantitative analysis, due to lack of control groups and/or only one study qualifying for meta-analysis. CONCLUSION: This study reports on the current significant risk factors for developing traumatic ACS. The most common risk factors included age, sex, gunshot wound with a vascular injury, OTA/AO fracture type C and high-energy trauma.
Authors: Daniel Zuchelli; Nicholas Divaris; Jane E McCormack; Emily C Huang; Neeta D Chaudhary; James A Vosswinkel; Randeep S Jawa Journal: J Surg Res Date: 2017-05-10 Impact factor: 2.192