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Lacking objective measures, the decision to perform fasciotomy is based on clinical findings and performed at a low level of suspicion. Biomarkers of muscle cell damage may help to identify and monitor patients at risk, similar to current routines for patients with acute myocardial infarction. This study will test the hypothesis that biomarkers of muscle cell damage can predict ACS in patients with tibial fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Patients aged 15\u201365 years who have suffered a tibial fracture will be included. Plasma (P)-myoglobin and P-creatine phosphokinase will be analysed at 6-hourly intervals after admission to the hospital (for 48 hours) and\u2014if applicable\u2014after surgical fixation or fasciotomy (for 24 hours). In addition, if ACS is suspected at any other point in time, blood samples will be collected at 6-hourly intervals. An independent expert panel will assess the study data and will classify those patients who had undergone fasciotomy into those with ACS and those without ACS. All primary comparisons will be performed between fracture patients with and without ACS. The area under the receiver operator characteristics curves will be used to identify the success of the biomarkers in discriminating between fracture patients who develop ACS and those who do not. Logistic regression analyses will be used to assess the discriminative abilities of the biomarkers to predict ACS corrected for prespecified covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study has been approved by the Regional Ethical Review Boards in Link\u00f6ping (2017\/514-31) and Helsinki\/Uusimaa (HUS\/2500\/2000). The BioFACTS study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\" xlink:href=\"NCT04674592\">NCT04674592<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-059918","type":"journal-article","created":{"date-parts":[[2022,5,2]],"date-time":"2022-05-02T12:12:19Z","timestamp":1651493539000},"page":"e059918","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["BioFACTS: biomarkers of rhabdomyolysis in the diagnosis of acute compartment syndrome \u2013 protocol for a prospective multinational, multicentre study involving patients with tibial fractures"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct04674592","registry":"10.18810\/clinical-trials-gov","type":"preResults"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0256-008X","authenticated-orcid":false,"given":"Abraham","family":"Nilsson","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Faculty of Health Science, Link\u00f6ping University Hospital, Linkoping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9658-8571","authenticated-orcid":false,"given":"Thomas","family":"Ibounig","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, and, University of Helsinki, Helsinki, 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