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Elevated intramuscular compartment pressures do not influence outcome after tibial fracture
Timothy O White1, Glyn E D Howell, Elizabeth M Will
1Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France, United Kingdom. twhite@rcsed.ac.uk
Background:
Although the importance of monitoring differential compartment pressures (Delta P) after tibial fractures has been established, many surgeons continue to use intramuscular pressures in diagnosing compartment syndrome, despite the limitations of this strategy. The cited reason for this is concern over leaving high intramuscular pressures untreated.
Methods:
One hundred one patients with tibial fractures with satisfactory Delta P were studied. Forty-one patients had elevated intramuscular pressures of over 30 mm Hg for more than 6 hours continuously. These patients were compared with a control group of 60 patients who had pressures of less than 30 mm Hg throughout. Outcome was measured prospectively in terms of muscular power and return to function over the year after injury.
Results:
No significant differences were found.
Conclusion:
Provided Delta P remains satisfactory, patients with elevated intramuscular pressures after tibial fracture do not have a greater incidence of complications than those with low pressures. These patients can therefore be observed safely.