COMPARTMENT PRESSURE MONITORING: A USEFUL ADJUNCT IN TIBIAL FRACTURES.

Abstract

Introduction: It is standard procedure in our unit to use compartment pressure monitoring in all patients presenting with tibial fractures. A sustained difference of less than 30mmhg between the diastolic blood pressure and the compartment pressure (known as the delta pressure) is taken as an indication for fasciotomy.

Aim: To review the impact continuous compartment pressure monitoring has on the management of patients with tibial fractures.

Methods and materials: Between January 2004 and June 2006, 28 patients admitted to our unit following tibial fracture had a compartment pressure monitor inserted. The outer sheath from a 16G cannula connected to an arterial manometer was used in each case.

The records of these 28 patients were reviewed. Twenty three were male. Ages ranged from 19 to 83 years old. Eight patients had open fractures and 20 had closed fractures. Seven patients (25%) had difficulties with communication which could have impeded or delayed the diagnosis of a compartment syndrome.

Results: Average delta pressure ranged from nine to 69mmHg in our patient population. High energy injuries resulted in a significantly lower delta pressure (p=0.05). Open fractures were more likely to result from high energy, although this was not statistically significant (p=0.068). Two patients had fasciotomy performed based on clinical picture and a sustained decrease in delta pressure. No patient had a missed compartment syndrome.

Conclusion: Continuous compartment pressure monitoring is especially useful in patients who are most at risk for compartment syndrome i.e. those having sustained high energy injury or open fractures. It can also aid decision making when the clinical picture of compartment syndrome is equivocal, or when a patient’s ability to communicate pain is impaired.

However, due to the ease of use and the low cost involved, we recommend that all patients with tibial fracture should have continuous compartment pressure monitoring performed.