COMPARTMENT PRESSURE IN ASSOCIATION WITH CLOSED TIBIAL FRACTURES - THE RELATIONSHIP BETWEEN TISSUE PRESSURE, COMPARTMENT, AND THE DISTANCE FROM THE SITE OF THE FRACTURE

We studied twenty-five consecutive patients who had a closed tibial fr acture to determine whether there was a relationship between compartme nt pressure and the distance at which the pressure was measured from t he site of the fracture. Tissue pressure was measured in all four comp artments of the leg at the level of the fracture and at five-centimete r increments proximal and distal to the fracture. The peak pressure wa s usually found at the level of the fracture and was always located wi thin five centimeters of the fracture. The highest pressures were reco rded in the anterior and the deep posterior compartments in twenty pat ients, including all five of those who had had a fasciotomy. The measu red pressure decreased steadily when sampled at increasing distances p roximal and distal to the site of the highest recorded pressure. Decre ases of twenty millimeters of mercury (2.67 kilopascals) five centimet ers adjacent to the site of the peak pressure were common. Compartment syndrome was diagnosed in five patients on the basis of clinical find ings, and the diagnosis was confirmed when peak compartment pressures of more than the critical threshold (within twenty-millimeters of merc ury [2.67 kilopascals] of the diastolic blood pressure) were recorded. Three of these five patients had measured pressures that were less th an the critical threshold within five centimeters of the site of the p eak pressure. Failure to measure tissue pressure,within a few centimet ers of the zone of peak pressure may result in a serious underestimati on of the maximum compartment pressure. Our results suggest that measu rements should be performed in both the anterior and the deep posterio r compartments at the level of the fracture as well as at locations pr oximal and distal to the zone of the fracture to determine reliably th e location of the highest tissue pressure in a lower extremity when a compartment syndrome is suspected clinically. The highest pressure sho uld be used in the decision-making process.