O3231: Risk of Acute Compartment Syndrome in Pediatric Patients with Tibial Tubercle Avulsion Fractures: A Retrospective Review

Background: Tibial tubercle avulsion fractures (TTAF) account for an estimated 2.7% of pediatric fractures. These injuries often require surgical intervention and have been historically thought to confer risk of acute compartment syndrome (ACS). Due to inconsistent evidence regarding the magnitude of this risk, these patients are often admitted for compartment monitoring. However, the necessity of this inpatient observation remains unclear. This study sought to review our institution’s experience with compartment syndrome following TTAF in pediatric patients.

Methods: A retrospective review was conducted of all patients ≤18 years old diagnosed with TTAF at our institution from January 1, 2005, to January 1, 2022. Radiological and clinical data were collected and reviewed to assess demographics, injury characteristics, and post-injury course. Acute compartment syndrome was defined either by clinical diagnosis or necessitating compartment fasciotomy. Average follow-up duration was 250 days.

Results: After relevant exclusions, a total of 48 patients were included in the final analysis. The mean age was 14 years (range: 10-18). Basketball was the most common mechanism of injury (48%) followed by soccer (10%) and football (10%). 30 patients (63%) were admitted to the hospital for at least one night after presentation. 46 (96%) underwent surgical fixation an average of 3.5 days after injury, most commonly the morning after admission. None of the patients developed acute compartment syndrome during their post-injury or postoperative course, and no complications were observed.

Conclusion: The results of this study suggest that the risk of acute compartment syndrome in pediatric patients with TTAF may be small enough to allow for same-day discharge following diagnosis or operative management. This finding could have significant implications for reducing healthcare costs and improving patient satisfaction by avoiding unnecessary overnight hospital stays. Further multicenter studies with larger sample sizes are needed to confirm these findings and determine whether there are any subgroups of patients who may be at higher risk for developing compartment syndrome.