Skip to main content

Advertisement

SpringerLink
Log in

The blister occurring in severe tibial plateau fractures (Schatzker V–VI) decreases the risk of acute compartment syndrome

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Severe tibial plateau fractures may result in acute compartment syndrome (ACS) of the leg, which is always considered to be an orthopaedic emergency. Blistering is not an uncommon sign and may be related to decreased compartment pressure. No experiments on the risk of ACS based on the presence of blisters after tibial plateau fractures have been conducted, and controversies about the high rate of ACS in patients with tibial plateau fractures still exist.

Questions/purposes

This research retrospectively followed the bicondylar tibial plateau fractures treated with locking plates and verified if the risk of ACS was decreased after a blister was observed.

Methods

A total of 100 patients with closed tibial fractures (63 men and 37 women) were included and divided into with blister (group A, 40) and without blister groups (group B, 60). The creatine kinase (CK), BUN, and chloride levels were recorded on the first day after hospitalization. The hospitalization costs and injury to operation time were collected in the two groups. The Lysholm knee score and a visual analogue scale (VAS) for pain were used to assess the rehabilitation after follow-up. Clinical and serological results of ACS in the two groups were compared.

Results

There was significant delay in the time from injury to operation (11.0 ± 3.5 VS 7.6 ± 7.2, Z = − 3.771, P < 0.001) in the with blister (group A) and without blister groups (group B). The levels of chloride and BUN were significantly lower in the with blister group than in the without blister group (102.7 ± 3.0 VS 104.7 ± 2.57 mg/dL, Z = − 3.33, P = 0.001) (10.3 ± 2.5 VS 10.3 ± 2.8 mg/dL, Z = − 2.366, P = 0.018). There were no significant differences in the CK levels in the with blister and without blister groups (285.8 ± 202.6 VS 408.4 ± 633.6 U/L, Z = − 1.379, P = 0.168), but a trend of decreasing to normal was obvious in patients with blisters. There were no significant differences in the Lysholm knee score (40 VS 60, 80 ± 4.9 VS 79.8 ± 3.0, Z = − 0.872, P = 0.383), or the VAS (40 VS 60, 1.6 ± 0.7 VS 2.2 ± 1.3, Z = − 1.568, P = 0.117) for pain compared with patients without blisters.

Conclusion

In conclusion, the presence of blisters in patients with severe tibial plateau fractures decreases the pressure in the compartment. There was a significant improvement in serological results after blisters appeared, which may be related to the reason for the decreased pressure decreased, and conservative management is recommended for these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The original data can be obtained through the corresponding author’s email.

References

  1. Ruffolo MR, Gettys FK, Montijo HE, Seymour RB, Karunakar MA (2015) Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma 29(2):85–90

    Article  Google Scholar 

  2. Uebbing CM, Walsh M, Miller JB, Abraham M, Arnold C (2011) Fracture blisters. West J Emerg Med 12(1):131–133

    PubMed  PubMed Central  Google Scholar 

  3. Guo J, Yin Y, Jin L, Zhang R, Hou Z, Zhang Y (2019) Acute compartment syndrome: Cause, diagnosis, and new viewpoint. Medicine 98(27):e16260

    Article  Google Scholar 

  4. Valdez C, Schroeder E, Amdur R, Pascual J, Sarani B (2013) Serum creatine kinase levels are associated with extremity compartment syndrome. J Trauma Acute Care Surg 74(2):441–445

    Article  CAS  Google Scholar 

  5. Rasmussen PS (1973) Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 55(7):1331–1350

    Article  CAS  Google Scholar 

  6. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C (2005) Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 439:207–214

    Article  CAS  Google Scholar 

  7. Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF (2008) A comparative study of less invasive stabilization system (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 15(2):139–143

    Article  Google Scholar 

  8. Unno F, Lefaivre KA, Osterhoff G, Guy P, Broekhuyse HM, Blachut PA, OʼBrien P (2017) Is early definitive fixation of bicondylar tibial plateau fractures safe? An observational cohort study. J Orthop Trauma 31(3):151–157

    Article  Google Scholar 

  9. Mills WJ, Nork SE (2002) Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin North Am 33(1):177–198

    Article  Google Scholar 

  10. Bae DS, Kadiyala RK, Waters PM (2001) Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop 21(5):680–688

    CAS  PubMed  Google Scholar 

  11. Beebe MJ, Auston DA, Quade JH, Serrano-Riera R, Shah AR, Watson DT, Sanders RW, Mir HR (2017) OTA/AO Classification is highly predictive of acute compartment syndrome after tibia fracture: a cohort of 2885 fractures. J Orthop Trauma 31(11):600–605

    Article  Google Scholar 

  12. Heckman MM, Whitesides TE Jr, Grewe SR, Rooks MD (1994) Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Joint Surg Am 76(9):1285–1292

    Article  CAS  Google Scholar 

  13. Lor KKH, Yeoh NCS, Wong KP, Wee ATH (2017) Raised compartment pressures are frequently observed with tibial shaft fractures despite the absence of compartment syndrome: A prospective cohort study. J Orthop Surg (Hong Kong) 25(2):2309499017717362

    Google Scholar 

  14. Garner MR, Taylor SA, Gausden E, Lyden JP (2014) Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS J 10(2):143–152

    Article  Google Scholar 

  15. McQueen MM, Christie J, Court-Brown CM (1996) Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg (Br) 78(1):95–98

    Article  CAS  Google Scholar 

  16. Harris IA, Kadir A, Donald G (2006) Continuous compartment pressure monitoring for tibia fractures: does it influence outcome? J Trauma 60(6):1330–1335

    Article  Google Scholar 

Download references

Funding

The research was supported by the Precision Medicine of the natural science foundation of Hebei province, China (H2020206193). The research was supported by National Natural Science Foundation of China (82002281).

Author information

Author notes

  1. Jialiang Guo and Ze Gao contributed equally to this work.

Authors and Affiliations

  1. The School of Medicine, Nankai University, Tianjin, People’s Republic of China

    Jialiang Guo & Yingze Zhang

  2. Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China

    Jialiang Guo, Ze Gao, Ling Wang, Chen Feng & Zhiyong Hou

  3. NHC Key Laboratory of Intelligent Orthopeadic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China

    Zhiyong Hou & Yingze Zhang

  4. Chinese Academy of Engineering, Beijing, People’s Republic of China

    Yingze Zhang

Authors
  1. Jialiang Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ze Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ling Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chen Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhiyong Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yingze Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Zhiyong Hou , Yingze Zhang, Data curation: Ze Gao, Formal analysis: Jialiang Guo, Investigation: Ling Wang, Methodology: Jialiang Guo, Software: Chen Feng, Supervision: Zhiyong Hou, Yingze Zhang, Validation: Zhiyong Hou, Yingze Zhang, Visualization: Zhiyong Hou, Writing—original draft: Jialiang Guo.

Corresponding author

Correspondence to Zhiyong Hou.

Ethics declarations

Competing interests

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the institutional review board in the Third Hospital of Hebei Medical University.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Informed consent was obtained from all authors included in the study.

Additional information

We can not send the email directly through our email address, so we just send it from this method. Thank you very much.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Levels of evidence: III, restrospective study

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, J., Gao, Z., Wang, L. et al. The blister occurring in severe tibial plateau fractures (Schatzker V–VI) decreases the risk of acute compartment syndrome. International Orthopaedics (SICOT) 45, 743–749 (2021). https://doi.org/10.1007/s00264-020-04925-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04925-y

Keywords

Search

Navigation