title: Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures: a randomized prospective study.
abstract: OBJECTIVE
  To compare anterior and deep posterior compartment pressures during reamed and unreamed intramedullary nailing of displaced, closed tibial shaft fractures.
  
  
  METHODS
  Randomized prospective study.
  
  
  METHODS
  University Hospital/Level I trauma center.
  
  
  METHODS
  Forty-eight adults with forty-nine fractures treated with intramedullary nailing within three days of injury.
  
  
  METHODS
  After intraoperative placement of compartment pressure monitors, the tibia fractures were treated by either unreamed intramedullary nailing or reamed intramedullary nailing. A fracture table and skeletal traction were not used in any of these procedures.
  
  
  METHODS
  Compartment pressures and deltaP ([diastolic blood pressure] - [compartment pressure]) were measured immediately preoperatively, intraoperatively, and for twenty-four hours postoperatively.
  
  
  RESULTS
  Compartment syndrome did not occur in any patient. Peak average pressures were obtained during reaming in the reamed group (30.0 millimeters of mercury anterior compartment, 34.7 millimeters of mercury deep posterior compartment) and during nail insertion in the unreamed group (33.9 millimeters of mercury anterior compartment, 35.2 millimeters of mercury deep posterior compartment). The average pressures quickly returned to less than thirty millimeters of mercury and remained there for the duration of the study. The deep posterior compartment pressures were lower in the reamed group than in the unreamed group at ten, twelve, fourteen, sixteen, eighteen, twenty, twenty-two, and twenty-four hours postoperatively (p < 0.05 at each of these times. A statistically significant difference between anterior compartment pressures could not be shown with the numbers available. The deltaP values were greater than thirty millimeters of mercury at all times after nail insertion in both the reamed and unreamed groups.
  
  
  CONCLUSIONS
  These data support acute (within three days of injury) reamed intramedullary nailing of closed, displaced tibial shaft fractures without the use of a fracture table.
authors.affiliation: Division of Orthopaedics, University of Kentucky, Lexington, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Nassif
authors.forename: J T
authors.initials: JT
authors.lastname: Gorczyca
authors.forename: J K
authors.initials: JK
authors.lastname: Cole
authors.forename: K J
authors.initials: KJ
authors.lastname: Pugh
authors.forename: D
authors.initials: D
authors.lastname: Pienkowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000868:Anterior Compartment Syndrome / Q000175:diagnosis* / Q000209:etiology; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation*; D017102:Fracture Healing / Q000502:physiology; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011184:Postoperative Period; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome