Anurag Yadav1, Jyotirmay Sikdar2, Vikas Anand3, Ravinder Singh3, Vishal Sidhu4. 1. Resident, Department of Orthopaedics, MMIMSR, India. 2. Professor and Head, Department of Orthopaedics, MMIMSR, India. 3. Assistant Professor, Department of Orthopaedics, MMIMSR, India. 4. Senior Resident, Department of Orthopaedics, MMIMSR, India.
Abstract
BACKGROUND: Experience and literature regarding complications of lower extremity compartment syndrome led us to hypothesize that delayed diagnosis and limb loss are potentially preventable events. Clinical examination does play a role, but quantification of compartment pressure reading serves as confirmation and determines the need for surgical intervention and provides the only objective data in case of conflict. METHODS: We performed a prospective study of all cases of closed tibial fractures presenting to our trauma centre over a 3-year period (January 2009-June 2012). Variables reviewed included intra-compartmental pressure readings, location of the fracture and development of subsequent compartment syndrome requiring fasciotomy. Patients were divided into (1) Group A - proximal tibial fracture, (2) Group B - diaphyseal fracture and (3) Group C - Pilon fracture. Values of the injured and uninjured leg were taken and the data analyzed using SPSS version 22. RESULTS: 168 (41 females and 127 males) cases were analyzed. Mean pressure readings of the fractured limb were higher in Group A compared to the other groups. The mean difference in pressure values between the injured and uninjured limb recorded were of 15.1 mm Hg (Group A), 13.8 mm Hg (Group B) and 13.3 mm Hg (Group C). Patients who eventually underwent fasciotomy were 5 (10.8%) in Group A, 8 (10.3%) in Group B and 3 (6.8%) in Group C, and had initial baseline pressure difference of >18.5 mm Hg. CONCLUSION: These data underscore the importance of routine recording of initial intra-compartmental pressure and relation of difference in compartmental pressure between injured and uninjured limb to eventual development of compartment syndrome requiring fasciotomy.
BACKGROUND: Experience and literature regarding complications of lower extremity compartment syndrome led us to hypothesize that delayed diagnosis and limb loss are potentially preventable events. Clinical examination does play a role, but quantification of compartment pressure reading serves as confirmation and determines the need for surgical intervention and provides the only objective data in case of conflict. METHODS: We performed a prospective study of all cases of closed tibial fractures presenting to our trauma centre over a 3-year period (January 2009-June 2012). Variables reviewed included intra-compartmental pressure readings, location of the fracture and development of subsequent compartment syndrome requiring fasciotomy. Patients were divided into (1) Group A - proximal tibial fracture, (2) Group B - diaphyseal fracture and (3) Group C - Pilon fracture. Values of the injured and uninjured leg were taken and the data analyzed using SPSS version 22. RESULTS: 168 (41 females and 127 males) cases were analyzed. Mean pressure readings of the fractured limb were higher in Group A compared to the other groups. The mean difference in pressure values between the injured and uninjured limb recorded were of 15.1 mm Hg (Group A), 13.8 mm Hg (Group B) and 13.3 mm Hg (Group C). Patients who eventually underwent fasciotomy were 5 (10.8%) in Group A, 8 (10.3%) in Group B and 3 (6.8%) in Group C, and had initial baseline pressure difference of >18.5 mm Hg. CONCLUSION: These data underscore the importance of routine recording of initial intra-compartmental pressure and relation of difference in compartmental pressure between injured and uninjured limb to eventual development of compartment syndrome requiring fasciotomy.