The impacts of internal versus external fixation for tibial fractures with simultaneous acute compartment syndrome

  • Hossein Akbari Aghdam
  • Erfan Sheikhbahaei
  • Hamidreza Hajihashemi
  • Davoud Kazemi
  • Ali Andalib
Original Article • LOWER LIMB - FRACTURES



High-energy tibial fractures may cause compartment syndrome, which needs fasciotomy. However, in this procedure, close fractures become an open wound and choosing the best type of fixation for this situation has been a problem. We assumed early open reduction and internal fixation (ORIF) instead of late internal fixation or external fixation, or stage-based approach is a better method.


We collected fifty-seven medical records from 2012 to 2017 stored in Alzahra and Kashani University Hospital databases. We selected important information of their medical files, called the submitted phone numbers, and asked them to come to our clinic and examined their leg for any malunion and/or movement restriction postoperatively. We asked about pain and paresthesia in their leg. Twelve cases were excluded.


Demographic variables were not significantly different between these two groups. Deep infection, malunion, decreased range of motion in both knee and ankle joints, pain and paresthesia mainly occurred in external fixation group, except malunion (p value = 0.032), other variables were not statistically significant between two groups. More surgeries were performed predominantly for external fixation group (p value < 0.001). External fixation stayed 4.7 days longer at hospital although it was not statistically significant (p value = 0.108).


It is better to perform fasciotomy and ORIF simultaneously in one surgery to lower the number of surgeries, days of hospitalization, decrease the risk of deep infection, malunion and movement restriction although its postoperative outcomes were not considerably different from external fixation. We indicate that stage-based approach is accompanied by poor outcomes and lesser satisfaction.


Compartment syndrome Tibial fractures Fracture fixation Internal fracture fixation Postoperative complications Fasciotomy 



We appreciate Dr. Mohammad Ali Tahririan, Mr. Amir Salar Moazen Safaei and Dr. Mohammad Marasi for their kind support throughout this research and proofreading the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflict of interests.

Ethical approval

This study started after receiving its ethical approval from Isfahan University of Medical Sciences, department of medical ethics in research with registered inquiry of IR.MUI.REC.1395.1.066.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Hossein Akbari Aghdam
    • 1
  • Erfan Sheikhbahaei
    • 2
  • Hamidreza Hajihashemi
    • 2
  • Davoud Kazemi
    • 2
  • Ali Andalib
    • 1
  1. 1.Orthopaedic Surgery Department, School of Medicine, Kashani University HospitalIsfahan University of Medical SciencesIsfahanIran
  2. 2.Students Research Committee, School of MedicineIsfahan University of Medical SciencesIsfahanIran

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