DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20163129

Compartment pressure changes after closed fractures of tibia

Manju G. Pillai

Abstract


Background: Compartment syndrome is a potentially devastating situation. Raised intracompartmental pressure has been implicated as the primary pathogenic factor in compartment syndrome. The purpose of the study was early detection of compartment syndrome and corroborating the findings with other physical signs and symptoms, to prevent the onset of ischaemia and subsequent tissue changes that lead to crippling deformities.

Methods: The present study was conducted in the Department of Orthopaedics, Pushpagiri medical college hospital, Thiruvalla over a period of 12 months.  Closed fractures of tibia admitted to the casualty unit within 36 hours of injury were selected for the study. A total of 24 patients were included with the majority in the age group of 31– 45 years. Whitesides technique was used to measure the compartment pressure. A differential pressure of less than 30 mm Hg was taken as the criterion for diagnosis of compartment syndrome. 

Results: The present study included 24 patients with affected 25 limbs.15 out of 25 limbs were with lower third fractures (60%) followed by upper third 6 (24%) and middle third 4 (16%). Out of 25 limbs 20 cases (80%) had associated fracture of fibula and 5 (20%) were not associated. In this study, out of 32% cases with increased compartment pressure, one case with upper third fracture (above 45 mm Hg) and one of the case with middle third fracture (20-30 mm Hg) with associated fibula had underwent immediate fasciotomy.

Conclusion: Compartment pressure measurement is a very good index for predicting and preventing compartment syndrome. Fasciotomy to fully decompress all involved compartments is the definitive treatment for compartment syndrome in the great majority of cases. Delays in performing fasciotomy increase morbidity.

Keywords


Ischemic contracture, Compartment syndrome, Closed fractures, Pressure changes

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References


Pettitt DA, McArthur P. Clinical review: Volkmann’s ischaemic contracture. European Journal of Trauma and Emergency Surgery. 2012;38(2):129-137.

DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. 1981;160:175-84.

McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996;78(1):95-8.

Blick SS, Brumback RJ, Poka A, Burgess AR, Ebraheim NA. Compartment syndrome in open tibial fractures. J Bone Joint Surg Am. 1986;68(9):1348-53.

Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S. Compartment Syndrome of the Lower Leg and Foot. Clin Orthop Relat Res. 2010;468(4):940–50.

DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. 1981;160:175-84.

Whitesides TE Jr, Haney TC, Harada H, Holmes HE, Morimoto K. A simple method for tissue pressure determination. Arch Surg. 1975;110:1311-3.

Al Dadah OQ, Darrah C, Cooper A, Donell ST, Patel AD. Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures. Injury. 2008;39:1204-9.

Brostrom LA, Stark A, Svartengren G. Acute compartment syndrome in forearm fractures. Acta Orthop Scand. 1990;61:50-3.

Uppal GS, Smith RC, Sherk HH, Mooar P. Accurate compartment pressure measurement using the Intervenous Alarm Control (IVAC) Pump: Report of a technique. J Orthop Trauma 1992;6(1):87-89.

Rorabeck CH, Castle GSP, Hardic R, Logan L. Compartmental Pressure Measurements– An Experimental Investigation Using the Slit Catheter. Journal Of Trauma. 1981;21(6)446-9.

Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH. Acute compartment syndromes: diagnosis and treat- ment with the aid of the wick catheter. J Bone Joint Surg [Am]. 1978;60:1091-5.

Willy C, Gerngross H, Sterk J. Measurement of intracompartmental pressure with use of a new electronic transducer-tipped catheter system. J. Bone Joint Surg. Am. 1999;81(2):158-68.

Gershuni DH, Gosnik BB, Hargens AR, Gould RN, Forsythe RD, Mubarack SJ, Akesan WH. Ultrasound Evaluation of the Anterior Musculo-fascial Compartment of Leg Following Exercise. CORR. 1982;167:185-90.

Sangwan SS, Marya KM, Devgan A, Siwach RC, Kundu JS, Gupta PK. Critical evaluation of compartment pressure measurement by saline manometer in peripheral hospital set up. Trop Doct. 2003;33:100-3.

Ogunlusi JD, Oginni LM, Ikem IC. Compartmental pressure in adults in tibial fractures. Int Orthop. 2005;29:130-3.

Heckman MM, Whitesides TE, Grewe Sr, Rooks MD. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment and the distance from the site of the fracture. J Bone Joint Surg Am. 1994;76:1285-92.