The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Factors Associated with Development of Thigh Compartment Syndrome Following Subtrochanteric and Diaphyseal Femoral Fractures

Document Type : RESEARCH PAPER

Authors
Christopher Rivera-Pintado 1
Manan Patel 1
Giselle Hernandez 2
Daniel Gloekler 1
Krystal Hunter 1
Haley N Tornberg 1
Kenneth Graf 1
1 Cooper University Hospital, Camden, USA
2 University of Miami Health System, Miami, FL, USA
10.22038/abjs.2024.74322.3441
Abstract
Objectives: Acute compartment syndrome of the thigh (CST) is an ongoing challenge for orthopaedic 
surgeons as the diagnosis is often difficult to establish. Currently, there is a shortage of studies 
investigating risk factors for the development of thigh compartment s yndrome following subtrochanteric 
and diaphyseal femoral fractures. This study aimed to identify risk factors associated with the 
development of CST following femoral fractures.
Methods: Retrospective review performed in a level one trauma center from January 2011 to December 2020 for 
all patients with non-pathological acute subtrochanteric or diaphyseal femoral fractures. Variables collected included 
demographics, injury severity score (ISS) scores, mechanism of injury, classification of femoral fracture, open versus 
closed injuries, development of compartment syndrome, time to compartment syndrome diagnosis, number of 
subsequent surgeries, and primary wound closure versus split-thickness skin graft. The statistical analysis of this 
study included descriptive analysis, simple logistic regression, paired T-test, and Wilcoxon Signed Rank.
Results: Thirty-one (7.7%) patients developed thigh compartment syndrome following 403 subtrochanteric or 
diaphyseal femoral fractures. The mean (SD) age for those who developed CST was 27.35 (8.42). For every unit 
increase in age, the probability of developing CST decreased. Furthermore, male gender had 18.52 times greater 
probability of developing CST (P <0.001). AO/OTA 32-C3 and subtrochanteric femoral fracture patterns 
demonstrated 15.42 (P = 0.011) and 3.15 (P <0.001) greater probability of developing CST, respectively. Patients 
who presented to the hospital following a motor vehicle accident (MVA) or gunshot wound (GSW) had 5.90 (P= 
0.006) and 14.87 (P < 0.001) greater probability of developing CST, respectively. 
Conclusion: Patients who were male, younger in age, and had a 32-C3 and subtrochanteric femoral fractures were 
at increased probability of developing CST. High energy trauma also increased the risk of developing CST. A high 
index of suspicion should be expressed in patients with these risk factors.
 Level of evidence: III
Keywords
Diaphyseal femoral fracture Subtrochanteric femoral fracture
Thigh compartment fasciotomy
Thigh compartment syndrome
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 7
July 2024
Pages 515-521

  • Receive Date 13 August 2023
  • Revise Date 13 February 2024
  • Accept Date 01 May 2024