Tibial nailing causes compartment syndrome compared with external fixation in acute closed tibial fractures

Tibial nailing currently represents the gold standard of treatment for tibial fractures but has been associated with the development of postoperative compartment syndrome (CS). We looked at the incidence of postoperative CS requiring an unplanned fasciotomy in patients undergoing treatment with either intramedullary nailing or circular external fixation for acute closed tibial fractures. In 23 patients undergoing external fixation, no patients developed postoperative CS. In 113 patients undergoing tibial nailing, 12 (10.6%) developed CS postoperatively requiring unplanned fasciotomy. Further analysis of those patients developing CS showed that increased surgical time and the use of intraoperative traction were associated with an increased risk of CS. Tibial nailing is a traumatic procedure that can induce CS in patients who would otherwise not have developed this serious complication. This should be borne in mind when considering treatment options in patients with acute closed tibial fractures. © 2014 by Lippincott Williams & Wilkins.