Injury - 2026-08-19 - Journal Article
Epidemiological characteristics and temporal trends of adult acute compartment syndrome From 2015 to 2025.
Ruppert NF, Sanghvi PA, Good LM, Florentino SA, Berk AN, Adelstein JM, Farrell ND, Ochenjele G, Wetzel RJ, Napora JK
Topics
Key Takeaway
ACS incidence remained stable at 33 ± 2.17 cases per million patients annually from 2015–2025, with 30-day readmission of 42% and 30-day mortality of 6% in a national cohort of 10,045 fasciotomy patients.
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Summary
This study used TriNetX ICD-10 and CPT code queries to characterize demographics, comorbidities, anatomic distribution, and temporal trends of ACS requiring fasciotomy in adults over a decade. Lower extremity involvement accounted for 74% of cases, tibial shaft fractures were the most common associated orthopaedic injury (13%), and open injuries were the most common associated wound type (22%). Annual incidence was stable at 33 ± 2.17 cases per million, with 30-day AKI in 16% and 30-day mortality of 6%.
Key Limitation
Reliance on administrative coding without clinical validation means cases of missed ACS (no fasciotomy coded), inadequate fasciotomy, or miscoded diagnoses are entirely invisible to this dataset, likely underestimating true incidence and distorting outcome data.
Original Abstract
INTRODUCTION
Acute compartment syndrome (ACS) is a rare surgical emergency that carries limb- and life-threatening risk. Existing literature demonstrates limited patient cohorts, leaving knowledge gaps regarding the epidemiology, clinical characteristics, and outcomes of ACS. Using a large national dataset, this study characterized demographic variables, national trends, and epidemiological characteristics among patients undergoing fasciotomies for ACS.
METHODS
The TriNetX US Collaborative Network database was queried to identify patients aged 18 and older who underwent fasciotomy for ACS from 2015 to 2025 using relevant ICD-10 and CPT codes. The primary outcome was incidence proportion of ACS over time. Cohort characteristics were collected, including age, sex, race, body mass index (BMI), comorbidities, associated orthopedic injuries, anatomic location of compartment syndrome, and geographic distribution of patients. A secondary descriptive subgrouping of non-traumatic and traumatic ACS was also reported.
RESULTS
A total of 117,592,405 patients were identified from initial query within TriNetX, of which 10,045 patients were diagnosed with ACS. The mean age of the cohort was 44.8 ± 19.4 years with a mean BMI of 28.2 ± 6.9 kg/m 2 . Most patients were male (67%) and White (68%). Compartment syndrome was most often associated with open injuries (22%) and tibial shaft fractures (13%). Many cases involved the lower extremity (74%). The most common medical complications were inpatient readmission at 30 days (42%) and acute kidney injury at 30 days (16%). The rate of mortality was 4% within 7 days and 6% within 30 days. Annual incidence remained stable over the study period, averaging 33 ± 2.17 cases per million TriNetX patients, with yearly values ranging from 29 to 37 cases per million TriNetX patients.
CONCLUSIONS
ACS remains a rare condition, with most cases occurring with lower-extremity fractures. Overall incidence has remained stable over the previous decade. Future studies are needed to define risk profiles and outcomes.
LEVEL OF EVIDENCE
retrospective cohort study, level of evidence IV.