The Journal of Bone and Joint Surgery, Vol 68, Issue 9 1348-1353, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Compartment syndrome in open tibial fractures
SS Blick, RJ Brumback, A Poka, AR Burgess and NA Ebraheim
A retrospective review of the cases of 180 patients who had 198 acute open
fractures of the tibial shaft and were admitted to a multiple-trauma
referral center over a three-year period revealed an incidence of
accompanying compartment syndrome of 9.1 per cent (eighteen fractures in
sixteen patients). Each of the eighteen compartment syndromes was
documented by measurements of intracompartmental pressure that were
obtained by the saline-injection technique, and all were treated by
four-compartment fasciotomy. The incidence of compartment syndrome was
found to be directly proportional to the degree of injury to soft tissue
and bone; this complication occurred most often in association with a
comminuted, grade-III open injury to a pedestrian. The physician must
maintain a high index of suspicion to detect a compartment syndrome in the
patient who has multiple trauma, as its clinical signs and symptoms may be
masked by a closed injury of the head or the need for ventilatory support
or prolonged anesthesia for other surgical procedures.
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