Factors Associated with Development of Traumatic Acute Compartment Syndrome: A Systematic Review and Meta-analysis



1 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

2 Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

3 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

4 Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA-Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia

5 4 Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA 5 Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA


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.
Level of evidence: II


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