Cristina Patru², Alexandru Lisias Dimitriu^1,2*, Nicolae Marian Ciurea², Prodan Alina Mihaela³, Dragos Ene^1,3 and Razvan Ene^1,2

¹1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
²2Department of Orthopedics and Trauma, Clinical Emergency Hospital, Bucharest, Bucharest, Romania
³3Department of Surgery, Clinical Emergency Hospital, Bucharest, Romania, Bucharest, Romania

*Corresponding Author: Alexandru Lisias Dimitriu, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Received: April 25, 2024; Published: June 10, 2024

Abstract

Fracture of the tibia is one of the most common long-bone fracture worldwide. One of the most serious complications of tibial fractures is considered the acute compartment syndrome (ACS). If this complication is not treated it in time can lead to irreversible complications, like limb amputation, renal failure or even death. We found that clinical and histological aspects are essential for early diagnosis in CS; in case of suspicion, ICP can be measured, but the clinical symptoms and histologic exam are crucial. Increased consistency of muscular compartments is the central clinical feature of CS and, once detected, it must immediately raise the suspicion of CS; failure to do that can delay the diagnosis and, thus, proper treatment even until the injuries become irreversible.

The disturbances characteristic for CS affects primarily the microcirculation, so arterial pulse is present until the late stages of CS; that is why the presence of arterial peripheral pulse does not exclude the diagnosis of CS.

Histological evaluation confirmed the reaction to high ICP (ischemia): ballooning of the muscle fiber, erasure of the striated, myofibrillar structure, with homogenization of the sarcoplasm, centralization of striated muscle fiber nuclei; (nuclei leave the periphery/sarcolemma and gather towards the center of the striated muscle fiber).

In our study, we tried to find correlations of factors that can predispose to the development of compartment syndrome. Treatment of CS consists of any measure to decrease ICP; decompressive fasciotomy when CS is installed must be performed early and by a large incision, which must open all the muscular - compartments on all their length; otherwise, the remaining fascial structures act like tourniquet and the muscles will herniate and become necrotic. If bone stabilization is necessary, it will be performed avoiding any method which increase ICP, especially reaming. Post- operative local and general monitoring of the patient should address to all the possible.

 Keywords: Compartment Syndrome (CS); Polytrauma; Fasciotomy; Tibial Fracture; Intracompartmental Pressure (ICP)

References

1. Torlincasi AM., et al. “Acute Compartment Syndrome”. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Richard Lopez declares no relevant financial relationships with ineligible companies. Disclosure: Muhammad Waseem declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; (2024).
2. Haiducu C., et al. “The prevalence and the impact of sarcopenia in digestive cancers. A systematic review”. Romanian Journal of Internal Medicine 4 (2021): 328-344.
3. Pavelescu D., et al. “The role of multimodal analgesia in the decrease of postoperative surgical stress response in major neoplastic thoraco-abdominal surgery”. Chirurgia (Bucur)6 (2011): 723-728.
4. Lee C and O’Toole RV. “Compartment Syndrome in Polytrauma Patients”. In: Mauffrey C, Hak DJ, Martin IM, editors. Compartment Syndrome: A Guide to Diagnosis and Management. Cham (CH): Springer Copyright (2019): 133-44.
5. Gamulin A., et al. “Association between open tibia fractures and acute compartment syndrome: A retrospective cohort study”. Orthopaedics & Traumatology: Surgery & Research 5 (2022): 103188.
6. Kiel J and Kaiser K. “Tibial Anterior Compartment Syndrome”. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Kimberly Kaiser declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2024, StatPearls Publishing LLC.; (2024).
7. Lupescu O., et al. “Acute cellulitis as local reaction to orthopedic implant - case presentation”. Romanian Journal of Morphology and Embryology 3 (2016): 1137-1143.
8. Mirea R., et al. “In Vitro Physical-Chemical Behaviour Assessment of 3D-Printed CoCrMo Alloy for Orthopaedic Implants”. Metals6 (2021): 857.
9. Mirea R., et al. “In-Depth Comparative Assessment of Different Metallic Biomaterials in Simulated Body Fluid”. Materials 11 (2021): 2774.
10. Park S., et al. “Compartment syndrome in tibial fractures”. Journal of Orthopaedic Trauma7 (2009): 514-518.
11. Yang S., et al. “Risk Factors of Deep Vein Thrombosis in Adults with Acute Compartment Syndrome Following Lower Extremity Fractures”. Clinical and Applied Thrombosis/Hemostasis 29 (2023): 10760296231165053.
12. Lupescu D GM., et al. “Biochemical Markers with Predictive Value in Polytrauma Patients with Femoral Fractures”. Revista De Chimie10 (2018): 2762-2767.

Citation

Citation: Alexandru Lisias Dimitriu. “Tibial Fractures Complicated with Compartment Syndrome – Clinical and Histological Aspects”.Acta Scientific Medical Sciences 8.7 (2024): 63-70.

Copyright

Copyright: © 2024 Alexandru Lisias Dimitriu. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.