Compartment Monitoring in Tibial Fractures
November 2, 2020
During a period of 2 years and 7 months, a total of 116 patients with tibial diaphyseal fractures were monitored for anterior compartment pressure. Using Whiteside’s recommendation measuring delta pressure (30mmHg) as a threshold for fasciotomy, all cases of acute compartment syndrome were properly diagnosed, with no missed cases. If the delta pressure were not used within this study, a total of 50 patients (43%) diagnoses would have led to unnecessary fasciotomy.
In the series of cases performed by McQueen and Court-Brown, the use of the differential pressure of 30 mmHg as a threshold for a fasciotomy led to no missed cases of acute compartment syndrome. It has been greatly advised that decompression should be performed if the differential pressure level drops below 30mmHg.
Brief Case Description
The study performed by Whitesides clearly proves that absolute compartment pressure is an unreliable indication of the need for a fasciotomy. Had they used 30mmHg as the threshold for decompression, 53 of the 116 patients would have needed (unnecessary) fasciotomy. When using the delta pressure as proper evidence, only one patient required a fasciotomy within the first 12 hours, and 2 patients required a fasciotomy in the second 12 hours. If the delta pressure were not used within this study, a total of 50 patients (43%) would have had an unnecessary fasciotomy. Using Whiteside’s recommendation of the delta pressure (30mmHg) as a threshold for fasciotomy, all cases of acute compartment syndrome were properly diagnosed, with no missed cases.
Intervention and Outcome Summary
Whiteside’s et al (1975) was the first to consider the importance of relative or differential pressure levels, stating that ischemia begins when pressure rises within 10 to 30 mmHg of the diastolic blood pressure. The successful use of the differential pressure levels and compartment pressure monitoring of tissue pressure will assist in indicating when decompression is necessary. Whitesides also considered the diastolic pressure to be a key factor. A patient with a diastolic pressure of 80mmHg is likely to tolerate a tissue pressure of 30mmHg, but any hypotensive patient with a diastolic blood pressure like the tissue pressure is not.
The Journal of Bone & Joint Surgery
M. M. McQueen, C.M. Court-Brown