Elevated intramuscular compartment pressures do not influence outcome after tibial fracture.
BACKGROUND
Although the importance of monitoring differential compartment pressures (Delta P) after tibial fractures has been established, many surgeons continue to use intramuscular pressures in diagnosing compartment syndrome, despite the limitations of this strategy. The cited reason for this is concern over leaving high intramuscular pressures untreated.


METHODS
One hundred one patients with tibial fractures with satisfactory Delta P were studied. Forty-one patients had elevated intramuscular pressures of over 30 mm Hg for more than 6 hours continuously. These patients were compared with a control group of 60 patients who had pressures of less than 30 mm Hg throughout. Outcome was measured prospectively in terms of muscular power and return to function over the year after injury.


RESULTS
No significant differences were found.


CONCLUSIONS
Provided Delta P remains satisfactory, patients with elevated intramuscular pressures after tibial fracture do not have a greater incidence of complications than those with low pressures. These patients can therefore be observed safely.
White
Timothy O
TO
Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France, United Kingdom. twhite@rcsed.ac.uk
Howell
Glyn E D
GE
Will
Elizabeth M
EM
Court-Brown
Charles M
CM
McQueen
Margaret M
MM
D000203:Activities of Daily Living; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000868:Anterior Compartment Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013978:Tibial Fractures / Q000145:classification / Q000150:complications* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome