Compartment pressure in the carpal tunnel in distal fractures of the radius. A prospective study

In a prospective controlled study, carpal tunnel tissue pressures were determined in a group of 56 patients with distal dislocated fractures of the radius at initial presentation, immediately prior to and after reduction, and 1, 2, 4, 12, and 24 h after reduction. Depending on the severity of the trauma and delay to presentation at the hospital, initial measurements revealed raised pressure averaging 23 mm Hg, which further increased during reduction to 44 mm Hg. After 4 h the average pressure was 37 mm Hg, and it then dropped to 26 mm Hg after 12 h. For anatomical reasons the median nerve is quite vulnerable in the region of the wrist joint. Chronic pressure here may cause carpal tunnel syndrome. Acute pressure in the carpal tunnel, which according to our investigations represents a distinct compartment, results in an overt compartment syndrome. The possibility of a direct relationship between markedly elevated tunnel pressure and the development of Sudeck's dystrophy is discussed.