The Journal of Bone and Joint Surgery, Vol 76, Issue 9 1285-1292, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture
MM Heckman, TE Whitesides, SR Grewe and MD Rooks
Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.
We studied twenty-five consecutive patients who had a closed tibial
fracture to determine whether there was a relationship between compartment
pressure and the distance at which the pressure was measured from the site
of the fracture. Tissue pressure was measured in all four compartments of
the leg at the level of the fracture and at five-centimeter increments
proximal and distal to the fracture. The peak pressure was usually found at
the level of the fracture and was always located within five centimeters of
the fracture. The highest pressures were recorded in the anterior and the
deep posterior compartments in twenty patients, including all five of those
who had had a fasciotomy. The measured pressure decreased steadily when
sampled at increasing distances proximal and distal to the site of the
highest recorded pressure. Decreases of twenty millimeters of mercury (2.67
kilopascals) five centimeters adjacent to the site of the peak pressure
were common. Compartment syndrome was diagnosed in five patients on the
basis of clinical findings, and the diagnosis was confirmed when peak
compartment pressures of more than the critical threshold (within twenty
millimeters of mercury [2.67 kilopascals] of the diastolic blood pressure)
were recorded. Three of these five patients had measured pressures that
were less than the critical threshold within five centimeters of the site
of the peak pressure. Failure to measure tissue pressure within a few
centimeters of the zone of peak pressure may result in a serious
underestimation of the maximum compartment pressure. Our results suggest
that measurements should be performed in both the anterior and the deep
posterior compartments at the level of the fracture as well as at locations
proximal and distal to the zone of the fracture to determine reliably the
location of the highest tissue pressure in a lower extremity when a
compartment syndrome is suspected clinically. The highest pressure should
be used in the decision-making process.
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