[Increasing compartment pressure in tibial intramedullary nailing. A phenomenon inherent in the therapy?]

At the Department of Surgery of the Bergmannsheil Hospital, a total of 58 patients treated with intramedullary nailing were reviewed with reference to the condition of the soft tissue. During intra- and postoperative treatment a bilateral fasciotomy was required in 8 patients. The subfascial pressure in the deep flexor compartment measured in 11 patients during secondary closed placement of intramedullary nails showed a slight increase of pressure in the deep flexor compartment from 8 mmHg to 40 mmHg after extension of the leg positioned on the operating table. After reduction the pressure increased significantly, from 50 mmHg to 80 mmHg. The postoperative pressure measured after 20 min was less than 50 mmHg in 9 patients. In 2 patients with manifest compartment syndrome (compartment pressure greater than 50 mmHg) immediate fasciotomy was required. Besides commonly known traumatic effects, parameters inherent in the therapy caused an increase in compartment pressure were critically reviewed with reference to their clinical relevance. The reasons for an increase in compartment pressure during closed placement of intramedullary nails in the lower leg are high position of the leg (hydrostatic effect), stretching of the soft tissue by reduction (decrease of volume), and possibly hematoma with outflow into the deep flexor compartment (increase of content).