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[Compartment pressure after intramedullary fracture nailing]
S Skjeldal1, K Hvaal, K Strømsøe
1Ortopedisk avdeling Kirurgisk klinikk, Ullevål sykehus, Oslo.
Summary
Acute compartment syndrome following tibial fractures can be serious. This study found no clinical sequelae in patients treated with intramedullary nailing, despite a high fasciotomy rate.
Area of Science:
- Orthopedic Surgery
- Trauma Management
Background:
- Acute compartment syndrome (ACS) is a severe complication of tibial fractures, with an incidence of 1-10%.
- Intramedullary nailing is a common treatment for tibial diaphyseal fractures.
Purpose of the Study:
- To evaluate the incidence of clinical sequelae from acute compartment syndrome in patients undergoing intramedullary nailing for tibial diaphyseal fractures.
- To assess the rate of decompressive fasciotomy in this patient cohort.
Main Methods:
- A series of 60 patients with tibial diaphyseal fractures treated with intramedullary nailing were retrospectively reviewed.
- Tissue pressure monitoring was performed in 31 patients.
- Decompressive fasciotomy was indicated if compartment pressure exceeded 30 mm Hg for over 30 minutes.
Main Results:
- No patients in the series exhibited clinical sequelae of acute compartment syndrome.
- The incidence of performing decompressive fasciotomy was 18% in this cohort.
- Despite routine pressure monitoring and fasciotomy criteria, a significant number of patients underwent the procedure.
Conclusions:
- Intramedullary nailing for tibial diaphyseal fractures can be performed without subsequent clinical compartment syndrome.
- The high rate of fasciotomy suggests a low threshold for intervention or potential overtreatment in some cases.
- Further research may be warranted to refine indications for fasciotomy in this setting.