Differences between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome

  • Christopher UllEmail author
  • Oliver Jansen
  • Dominik Seybold
  • Matthias Königshausen
  • Thomas Armin Schildhauer
  • Jan GessmannEmail author
Original Article



To analyze the differences in outcomes between primary and secondary definitive osteosynthesis for fractures of the lower leg with concomitant acute compartment syndrome (ACS).


From our trauma database, we identified a total of 107 patients with 126 fractures of AO/OTA type 41–44 and 120 ACS from January 01, 2001 to December 31, 2015 who were treated with primary or secondary definitive osteosynthesis after concomitant fasciotomy.


Seventy-one patients with 77 fractures of AO/OTA classification type 41–44 suffering ACS received primary definitive osteosynthesis at the time of compartmental incision (POCI) and were compared to 36 patients with 49 fractures of AO/OTA type 41–44 and ACS, who received secondary definitive osteosynthesis after compartmental incision and soft tissue coverage (SOCI). Patients with POCI had a significantly shorter length of hospital stay with significantly fewer necessary surgeries to achieve definitive fracture treatment and soft tissue closure than SOCI patients (p ≤ 0.001). The overall rate of infections in both groups was 13%, without any difference between POCI and SOCI.


POCI for AO/OTA fractures type 41–44 with ACS is a safe and effective procedure without increasing the infection rate compared to a gradual treatment (SOCI). However, the possible selection bias due to the retrospective study design needs to be considered.


Acute compartment syndrome Complications Fasciotomy Osteosynthesis Tibia fracture 



Acute compartment syndrome


Arbeitsgemeinschaft fuer Osteosynthesefragen/Orthopedic trauma association


Advanced trauma life support


Body mass index


Center for disease controls




Open reduction and internal fixation


Primary definitive osteosynthesis after acute compartmental incision


Secondary definitive osteosynthesis after acute compartmental incision


Split skin grafting


Author contributions

CU: study design, data collection, data analysis, interpretation of data, and article preparation. OJ: data collection, data analysis, article preparation, and editorial oversight. DS: data analysis, article preparation, and editorial oversight. TAS: data analysis, article preparation, and editorial oversight. MK: data analysis, article preparation, and editorial oversight. JG: study design, data collection, data analysis, article preparation, and editorial oversight.

Compliance with ethical standards

Conflict of interest

C. Ull declares that he has no conflict of interest, O. Jansen declares that he has no conflict of interest, D. Seybold declares that he has no conflict of interest, M. Königshausen declares that he has no conflict of interest, T. A. Schildhauer declares that he has no conflict of interest, and J. Gessmann declares that he has no conflict of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal, consent is not required.

Informed consent

Informed consent was obtained from all the individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Christopher Ull
    • 1
    Email author
  • Oliver Jansen
    • 1
  • Dominik Seybold
    • 1
  • Matthias Königshausen
    • 1
  • Thomas Armin Schildhauer
    • 1
  • Jan Gessmann
    • 1
    Email author
  1. 1.Department of General and Trauma SurgeryBG University Hospital BergmannsheilBochumGermany

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