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

Document Type : RESEARCH PAPER

Authors

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

Main Subjects

References

1. Mithöfer K, Lhowe DW, Vrahas MS, Altman DT, Altman GT. 
Clinical Spectrum of Acute Compartment Syndrome of the 
Thigh and Its Relation to Associated Injuries. Clin Orthop 
Relat Res. 2004 :( 425):223-9. doi: 10.1097/00003086-
200408000-00032.
2. Schwartz JT, Brumback RJ, Lakatos R, Poka A, Bathon GH, 
Burgess AR. Acute compartment syndrome of the thigh. A 
spectrum of injury. J Bone Joint Surg Am. 1989; 71(3):392-
400.
3. Torlincasi AM, Lopez RA, Waseem M. Acute Compartment Syndrome. In: StatPearls. tudy Guide from StatPearls 
Publishing, Treasure Island (FL), 2017. 
4. Tillinghast CM, Gary JL. Compartment Syndrome of the Lower 
Extremity. In: Mauffrey C, Hak DJ, Martin III MP, eds. 
Compartment Syndrome. Springer International Publishing; 
2019. 
5. Ojike NI, Roberts CS, Giannoudis PV. Compartment syndrome 
of the thigh: A systematic review. Injury. 2010; 41(2):133-
136. doi:10.1016/j.injury.2009.03.016.
6. Knab LM, Abuzeid A, Rodriguez H, Issa N. Thigh compartment 
syndrome in urban trauma: bullets to blame, not collisions. J 
Surg Res. 2013; 185(2):748-752. 
doi:10.1016/j.jss.2013.07.003.
7. Riede U, Schmid MR, Romero J. Conservative treatment of an 
acute compartment syndrome of the thigh. Arch Orthop 
Trauma Surg. 2007; 127(4):269-275. doi:10.1007/s00402-
006-0199-1.
8. Javedani PP, Ratnabalasuriar R, Grall KJH. Spontaneous 
Compartment Syndrome of the Thigh in the Absence of 
Trauma. J Emerg Med. 2016; 51(1):70-72. 
doi:10.1016/j.jemermed.2016.04.001.
9. Rameder P, Schmidt R, Machold W, et al. Epidemiology, 
treatment and outcome after compartment syndrome of the 
thigh in 69 cases – Experiences from a level I trauma centre. 
Injury. 2019; 50(6):1242-1246. 
doi:10.1016/j.injury.2019.04.001.
10. Zuchelli D, Divaris N, McCormack JE, et al. Extremity 
compartment syndrome following blunt trauma: a level I 
trauma center’s 5-year experience. J Surg Res. 2017; 217:131-
136. doi:10.1016/j.jss.2017.05.012.
11. Slade HJT, De Ridder K. A rare cause of acute compartment 
syndrome in the thigh: a case report. J Surg Case Rep. 2020; 
2020(12):rjaa546. doi:10.1093/jscr/rjaa546.
12. Nooh A, Wang CK, AlAseem A, Harvey EJ, Bernstein M. Acute 
Thigh Compartment Syndrome due to an Occult Arterial 
Injury Following a Blunt Trauma: A Case Report. JBJS Case 
Connect. 2020; 10(1):e0506-e0506. 
doi:10.2106/JBJS.CC.18.00506.
13. Kreibich M, Czerny M, Benk C, Beyersdorf F, Rylski B, 
Trummer G. Thigh compartment syndrome during 
extracorporeal life support. J Vasc Surg Venous Lymphat 
Disord. 2017; 5(6):859-863. doi:10.1016/j.jvsv.2017.07.005.
14. Schimelpfenig S, Liddell T, Page E. A Case of Acute 
Compartment Syndrome of the Thigh Associated with 
Repetitive Athletic Trauma. S D Med. 2016; 69(12):553-555.
15. Uzel AP, Bulla A, Henri S. Compartment syndrome of the thigh 
after blunt trauma: a complication not to be ignored. 
Musculoskelet Surg. 2013; 97(1):81-83. doi:10.1007/s12306-
011-0176-x.
16. Colosimo AJ, Ireland ML. Thigh compartment syndrome in a 
football athlete: a case report and review of the literature. 
Med Sci Sports Exerc. 1992; 24(9):958-963.
17. Verwiebe EG, Kanlic EM, Saller J, Abdelgawad A. Thigh 
Compartment Syndrome, Presentation and Complications. 
Bosn J Basic Med Sci. 2009; 9(1):S28-S33. 
doi:10.17305/bjbms.2009.2751.
18. Palmer C. Major trauma and the injury severity score--where 
should we set the bar? Annu Proc Assoc Adv Automot Med. 
2007; 51:13-29.
19. Mithoefer K, Lhowe DW, Vrahas MS, Altman DT, Erens V, 
Altman GT. Functional outcome after acute compartment 
syndrome of the thigh. J Bone Joint Surg Am. 2006; 
88(4):729-737. doi:10.2106/JBJS.E.00336.
The Archives of Bone and Joint Surgery
Volume 12, Issue 7
July 2024
Pages 515-521

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History

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

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