Abstract
BACKGROUND: This study aimed to investigate the utility of shear wave elastography (SWE) as a noninvasive diagnostic tool for assessing anterior compartment intracompartmental pressure (ICP) in patients with tibial plateau fractures, facilitating early detection of high compartment pressure (HCP) to mitigate acute compartment syndrome (ACS) risks. METHODS: In this cross-sectional study conducted from January 2024 to March 2025 at a tertiary hospital in China, 170 patients aged 18-65 years with tibial plateau fractures diagnosed within 48 h were enrolled. Demographic data, injury mechanisms, Schatzker classification, and laboratory parameters were collected. shear wave velocity (SWV) was measured via SWE on both injured and contralateral anterior compartment muscles, alongside invasive ICP monitoring. Statistical analyses encompassed Spearman's correlations, stepwise logistic regression for a multivariate model incorporating SWV, age, and fracture type, and receiver operating characteristic (ROC) curves for diagnostic performance. RESULTS: Among participants (57.1% male, median age 45 years), 44 exhibited HCP (ICP ≥ 30 mmHg). Injury-side SWV and SWV differential showed strong positive correlations with ICP (ρ = 0.704 and 0.535, respectively; both P < 0.001). Significant SWV disparities were observed between HCP and non-HCP groups (P < 0.001). The multivariate model yielded an AUC of 0.880, with 93.2% sensitivity and 71.4% specificity, demonstrating consistent performance across gender subgroups. Adjusted odds ratios highlighted injury-side SWV (aOR 5.99) and Schatzker Ⅳ-Ⅵ fractures (aOR 4.14) as key predictors. CONCLUSION: Our study results indicate that SWE can reliably and noninvasively detect HCP in tibial plateau fractures, providing superior diagnostic accuracy and clinical applicability.