Jose I Torrero1,2, Francesc Aroles3. 1. Orthopedic and Trauma Unit, Nostra Senyora de Meritxell Hospital, Escaldes, Principality of Andorra. nachotorrero@hotmail.com. 2. Nostra Senyora de Meritxell Hospital, Escaldes, Principality of Andorra. nachotorrero@hotmail.com. 3. Department of Anesthesiology, Nostra Senyora de Meritxell Hospital, La Massana, Principality of Andorra.
Abstract
BACKGROUND: Tibial shaft fractures are the commonest cause of compartment syndrome. Intramedullary nails have been the most common treatment for such fractures. Raised pressures after nailing do not necessarily imply compartment syndrome, but are an important factor to consider when deciding on the appropriate treatment. METHODS: A clinical study was performed that included 80 cases diagnosed with tibial shaft fractures and treated with reamed intramedullary nails. Compartment pressure was measured with a slit catheter. The pressure was calculated before and just after surgery. Delta P values were also calculated. Patients with overpressure but no clinical suspicion of compartment syndrome were monitored for 24 h. Patients diagnosed with compartment syndrome were treated via fasciotomy. A descriptive and statistical study was performed with 95% confidence intervals and significant difference p < 0.05. RESULTS: A statistically significant increase in pressure was observed after surgery. Delta P values only decreased after nailing in the anterior compartment, although the decrease was not significant (p ≥ 0.05). Four cases required monitoring for 24 h. Eleven patients were diagnosed with compartment syndrome after surgery, with absolute pressures of over 30 mmHg and delta P values of less than 40 mmHg. CONCLUSIONS: Reamed intramedullary nails can increase compartment pressures in tibial shaft fractures. The delta P value can influence the decision about whether to perform a fasciotomy. The diagnosis of compartment syndrome must be based on clinical findings. If there is any doubt, we recommend measuring the pressure and using a cut-off value for fasciotomy of delta P ≤ 40 mmHg. A delay in definitive treatment is suggested until pressure values are secure.
BACKGROUND: Tibial shaft fractures are the commonest cause of compartment syndrome. Intramedullary nails have been the most common treatment for such fractures. Raised pressures after nailing do not necessarily imply compartment syndrome, but are an important factor to consider when deciding on the appropriate treatment. METHODS: A clinical study was performed that included 80 cases diagnosed with tibial shaft fractures and treated with reamed intramedullary nails. Compartment pressure was measured with a slit catheter. The pressure was calculated before and just after surgery. Delta P values were also calculated. Patients with overpressure but no clinical suspicion of compartment syndrome were monitored for 24 h. Patients diagnosed with compartment syndrome were treated via fasciotomy. A descriptive and statistical study was performed with 95% confidence intervals and significant difference p < 0.05. RESULTS: A statistically significant increase in pressure was observed after surgery. Delta P values only decreased after nailing in the anterior compartment, although the decrease was not significant (p ≥ 0.05). Four cases required monitoring for 24 h. Eleven patients were diagnosed with compartment syndrome after surgery, with absolute pressures of over 30 mmHg and delta P values of less than 40 mmHg. CONCLUSIONS: Reamed intramedullary nails can increase compartment pressures in tibial shaft fractures. The delta P value can influence the decision about whether to perform a fasciotomy. The diagnosis of compartment syndrome must be based on clinical findings. If there is any doubt, we recommend measuring the pressure and using a cut-off value for fasciotomy of delta P ≤ 40 mmHg. A delay in definitive treatment is suggested until pressure values are secure.
Entities:
Keywords:
Fractures; General trauma; Intramedullary nailing of long bones; Lower extremity trauma; Lower limb injuries