Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2017; 8(5): 385-393
Published online May 18, 2017. doi: 10.5312/wjo.v8.i5.385
Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure
Saumitra Goyal, Monappa A Naik, Sujit Kumar Tripathy, Sharath K Rao
Saumitra Goyal, Monappa A Naik, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal 576104, India
Sujit Kumar Tripathy, Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
Sharath K Rao, Department of Orthopedics, Kasturba Medical College, Manipal University, Manipal 576104, India
Author contributions: Goyal S conducted the study and drafted the manuscript; Naik MA and Rao SK designed the study and provided intellectual input; Goyal S and Tripathy SK collected the data, reviewed the data and conducted the statistical analysis; all authors read and approved the final manuscript.
Institutional review board statement: Ethical clearance for this study was obtained from the Manipal University Institutional ethics committee.
Informed consent statement: All participants have provided written consent for inclusion in this study.
Conflict-of-interest statement: The authors of this manuscript declare that they have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Sujit Kumar Tripathy, MS, DNB, MNAMS, Dip SICOT, Associate Professor, Department of Orthopedics, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar 751019, India.
Telephone: +91-0674-2476781
Received: November 26, 2016
Peer-review started: November 29, 2016
First decision: February 17, 2017
Revised: March 4, 2017
Accepted: March 23, 2017
Article in press: March 24, 2017
Published online: May 18, 2017

To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome (ACS) and to correlate it with functional outcome.


Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale (LEFS)] and complications were assessed.


Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk (10 to 54 wk) and 23.8 ± 9.2 wk (12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness (76%) that caused difficulty in walking, running and squatting. Of 21 patients who had paralysis at diagnosis, 13 (62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients (48.3%) with severe disability, 10 patients (34.5%) with moderate disability and 5 patients (17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmHg respectively (P < 0.001).


ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intra-compartmental pressure (ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

Keywords: Compartment syndrome, Leg, Tibial fracture, Deep posterior compartment, Intracompartmental pressure, Functional outcome

Core tip: Anterior and deep posterior compartments are commonly involved in acute compartment syndrome (ACS) of leg after tibial fracture. Assessment of functional outcome in these patients and correlation with deep posterior compartment pressure has never been reported. This study revealed that ACS in tibial fractures causes severe functional disability and about 48% patients were severely disabled at one year. But this study did not find statistically significant relation between fracture union rate and deep compartment pressure value. The intra-compartmental pressure correlates with functional disability. Patients with relatively high pressure are prone for severe residual pain and poor functional outcome.