Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases
Abstract Purpose The primary aim of this study was to investigate the risk factors associated with poor outcomes following acute compartment syndrome (ACS) of lower leg. The secondary objective was to determine if delayed fasciotomy is linked to poor outcomes. Methods In this retrospective case cont...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-024-04719-7 |
| _version_ | 1797199353890209792 |
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| author | Zhe Lin Zhiyong Hou Jialiang Guo Yongsheng Lin Yingze Zhang |
| author_facet | Zhe Lin Zhiyong Hou Jialiang Guo Yongsheng Lin Yingze Zhang |
| author_sort | Zhe Lin |
| collection | DOAJ |
| description | Abstract Purpose The primary aim of this study was to investigate the risk factors associated with poor outcomes following acute compartment syndrome (ACS) of lower leg. The secondary objective was to determine if delayed fasciotomy is linked to poor outcomes. Methods In this retrospective case control study approved by the institutional review board, we identified 103 patients with ACS of the lower leg. Poor outcome was defined as a composite variable that included limb amputation, neurological deficit and contracture. Among these, 44 patients exhibited poor outcome while 59 patients demonstrated a good outcome. Patient-related factors, laboratory values, and treatment-related factors were analyzed using electronic medical records. Univariate statistical and logistic regression analyses were conducted to determine significance. Results Bivariate analyses showed that the mechanism of injury (P = 0.021), open injury (P = 0.001), arterial injury (P<0.001), hemoglobin levels (HB) (P < 0.001), white blood cell count (WBC) (P = 0.008), albumin levels (ALB) (P<0.001), creatine kinase levels (CK) at presentation (P = 0.015), CK at peak (P<0.001), creatine kinase levels (Ca) (P = 0.004), dehydrating agent (P = 0.036), and debridement (P = 0.005) were found to be associated with the risk of poor outcomes. Logistic regression analyses revealed that arterial injury [ P< 0.001, OR = 66.172, 95% CI (10.536, 415.611)] was an independent risk factor for poor outcomes. However, HB [P = 0.005, OR = 0.934, 95% CI (0.891, 0.979)] was a protective factor against poor outcomes. Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of HB to prevent poor outcome following ACS was 102.45 g/L. Conclusions ACS of the lower leg is a serious complication often associated with a poor prognosis. Patients with arterial injury or lower HB have a significantly increased risk of having poor outcomes. Poor outcomes were not found to be associated with the timing of fasciotomy in this study. |
| first_indexed | 2024-04-24T07:14:25Z |
| format | Article |
| id | doaj.art-b7cedfeee8764f15a996698f6d47391b |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-24T07:14:25Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-b7cedfeee8764f15a996698f6d47391b2024-04-21T11:25:04ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2024-04-011911810.1186/s13018-024-04719-7Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 casesZhe Lin0Zhiyong Hou1Jialiang Guo2Yongsheng Lin3Yingze Zhang4Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical UniversityDepartment of Orthopaedic Surgery, The Third Hospital of Hebei Medical UniversityDepartment of Orthopaedic Surgery, The Third Hospital of Hebei Medical UniversityDepartment of Orthopaedic Surgery, The Third Hospital of Hebei Medical UniversityDepartment of Orthopaedic Surgery, The Third Hospital of Hebei Medical UniversityAbstract Purpose The primary aim of this study was to investigate the risk factors associated with poor outcomes following acute compartment syndrome (ACS) of lower leg. The secondary objective was to determine if delayed fasciotomy is linked to poor outcomes. Methods In this retrospective case control study approved by the institutional review board, we identified 103 patients with ACS of the lower leg. Poor outcome was defined as a composite variable that included limb amputation, neurological deficit and contracture. Among these, 44 patients exhibited poor outcome while 59 patients demonstrated a good outcome. Patient-related factors, laboratory values, and treatment-related factors were analyzed using electronic medical records. Univariate statistical and logistic regression analyses were conducted to determine significance. Results Bivariate analyses showed that the mechanism of injury (P = 0.021), open injury (P = 0.001), arterial injury (P<0.001), hemoglobin levels (HB) (P < 0.001), white blood cell count (WBC) (P = 0.008), albumin levels (ALB) (P<0.001), creatine kinase levels (CK) at presentation (P = 0.015), CK at peak (P<0.001), creatine kinase levels (Ca) (P = 0.004), dehydrating agent (P = 0.036), and debridement (P = 0.005) were found to be associated with the risk of poor outcomes. Logistic regression analyses revealed that arterial injury [ P< 0.001, OR = 66.172, 95% CI (10.536, 415.611)] was an independent risk factor for poor outcomes. However, HB [P = 0.005, OR = 0.934, 95% CI (0.891, 0.979)] was a protective factor against poor outcomes. Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of HB to prevent poor outcome following ACS was 102.45 g/L. Conclusions ACS of the lower leg is a serious complication often associated with a poor prognosis. Patients with arterial injury or lower HB have a significantly increased risk of having poor outcomes. Poor outcomes were not found to be associated with the timing of fasciotomy in this study.https://doi.org/10.1186/s13018-024-04719-7Acute compartment syndromeCrusFasciotomyArterial injury |
| spellingShingle | Zhe Lin Zhiyong Hou Jialiang Guo Yongsheng Lin Yingze Zhang Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases Journal of Orthopaedic Surgery and Research Acute compartment syndrome Crus Fasciotomy Arterial injury |
| title | Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases |
| title_full | Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases |
| title_fullStr | Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases |
| title_full_unstemmed | Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases |
| title_short | Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases |
| title_sort | risk factors for poor outcomes in patients with acute lower leg compartment syndrome a retrospective study of 103 cases |
| topic | Acute compartment syndrome Crus Fasciotomy Arterial injury |
| url | https://doi.org/10.1186/s13018-024-04719-7 |
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