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Analysis of acute extremity compartment syndrome using a genealogic population database

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Acute extremity compartment syndrome (“CS”) is an under-researched, highly morbid condition affecting trauma populations. The purpose of this study was to analyze incidence rates and risk factors for extremity compartment syndrome using a high-quality population database. Additionally, we evaluated heritable risk for CS using available genealogic data. We hypothesized that diagnosis of extremity compartment syndrome would demonstrate heritability.

Materials and methods

Adult patients with fractures of the tibia, femur, and upper extremity were retrospectively identified by ICD-9, ICD-10, and CPT codes from 1996 to 2020 in a statewide hospital database. Exposed and unexposed cohorts were created based on a diagnosis of CS. Available demographic data were analyzed to determine risk factors for compartment syndrome using logistic regression. Mortality risk at the final follow-up was evaluated using Cox proportional hazard modeling. Patients with a diagnosis of CS were matched with those without a diagnosis for heritability analysis.

Results

Of 158,624 fractures, 931 patients were diagnosed with CS. Incidence of CS was 0.59% (tibia 0.83%, femur 0.31%, upper extremity 0.27%). Male sex (78.1% vs. 46.4%; p < 0.001; RR = 3.24), younger age at fracture (38.8 vs. 48.0 years; p < 0.001; RR = 0.74), Medicaid enrollment (13.2% vs. 9.3%; p < 0.001; RR = 1.58), and smoking (41.1% vs. 31.1%; p < 0.001; RR 1.67) were significant risk factors for CS. CS was associated with mortality (RR 1.61, p < 0.001) at mean follow-up 8.9 years in the CS cohort. No significant heritable risk was found for diagnosis of CS.

Conclusions

Without isolating high-risk fractures, rates of CS are lower than previously reported in the literature. Male sex, younger age, smoking, and Medicaid enrollment were independent risk factors for CS. CS increased mortality risk at long-term follow-up. No heritable risk was found for CS.

Level of evidence

III.

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Data availability

Data may be available by request.

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Acknowledgements

We thank the Pedigree and Population Resource of Huntsman Cancer Institute, University of Utah (funded in part by the Huntsman Cancer Foundation) for its role in the ongoing collection, maintenance, and support of the Utah Population Database (UPDB). We also acknowledge partial support for the UPDB through grant P30 CA2014 from the National Cancer Institute, University of Utah and from the University of Utah’s program in Personalized Health and Center for Clinical and Translational Science. Research was supported by the NCRR grant, “Sharing Statewide Health Data for Genetic Research” (R01 RR021746, G. Mineau, PI) with additional support from the Utah Department of Health and the University of Utah.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA

    Dillon C. O’Neill, Lillia N. Steffenson, Luke A. Myhre, Adam H. Kantor, Lucas S. Marchand & Justin M. Haller

  2. Utah Population Database, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Huong D. Meeks & Alison M. Fraser

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  1. Dillon C. O’Neill
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Contributions

DO’, LS, LM, and AK contributed to study design, literature review, research approvals, and manuscript writing for this study. HM and AF contributed data collection and statistical analysis. LM and JH contributed to study design and critical revision.

Corresponding author

Correspondence to Justin M. Haller.

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Conflict of interest

Dillon O’Neill, Lillia Steffenson, Luke Myhre, Adam Kantor, Huong Meeks, Alison Fraser, and Lucas Marchand have no conflicts of interest to declare. Justin Haller is a paid consultant for NewClip Technics, Orthogrid, Osteocentric, and Stryker. He is a board member of the Orthopaedic Trauma Association and the Western Orthopedic Association.

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O’Neill, D.C., Steffenson, L.N., Myhre, L.A. et al. Analysis of acute extremity compartment syndrome using a genealogic population database. Arch Orthop Trauma Surg 144, 149–160 (2024). https://doi.org/10.1007/s00402-023-05074-8

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  • DOI: https://doi.org/10.1007/s00402-023-05074-8

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