Raised compartment pressures are frequently observed with tibial shaft fractures despite the absence of compartment syndrome: A prospective cohort study.
PURPOSE
To measure the intracompartmental pressures surrounding tibial fractures not exhibiting any clinical evidence of compartment syndrome. Our hypothesis was that pressures often exceed the recommended threshold of fasciotomy despite the absence of compartment syndrome, and hence diagnosis based on pressure measurements alone is unreliable.


METHODS
Thirteen consecutive patients with closed tibial shaft fractures without clinical suspicion of compartment syndrome, and who were planned for intramedullary nailing, were prospectively enrolled. Compartment pressures ( P) in all four compartments of the affected leg were measured at the start of surgery and immediately after tibial reaming, and differential pressures (delta P) were calculated based on the diastolic blood pressure prior to induction of anaesthesia.


RESULTS
No patients required reoperation in the post-operative period, as a result of an undiagnosed compartment syndrome. Using commonly quoted threshold pressure criteria, 62% (using P > 30 mmHg) and 23% of patients (using delta P < 30 mmHg) have been incorrectly diagnosed with compartment syndrome.


CONCLUSIONS
We conclude that raised compartment pressures are frequently seen in patients with tibial shaft fractures; but in most cases, it does not equate to the presence of compartment syndrome. Diagnosis of compartment syndrome based on intracompartmental pressure measurements alone may result in unnecessary fasciotomies in a sizeable number of patients. Compartment syndrome remains a clinical diagnosis, and one which always needs to be considered when managing tibial fractures.
['Lor|Kelvin Kah Ho|KKH|', 'Yeoh|Nicholas Ching Sing|NCS|', 'Wong|Khai Phang|KP|', 'Wee|Andy Tech Huat|ATH|']
D000328:Adult D003161:Compartment Syndromes D000071938:Fasciotomy D005260:Female D005594:Fracture Fixation, Intramedullary D006801:Humans D008297:Male D008875:Middle Aged D011312:Pressure D011446:Prospective Studies D015203:Reproducibility of Results D013978:Tibial Fractures
compartment syndrome tibial fracture compartment pressure measurements