COMPARTMENT PRESSURE IN NAILED TIBIAL FRACTURES - A THRESHOLD OF 30 MMHG FOR DECOMPRESSION GIVES 29-PERCENT FASCIOTOMIES

During the past few years we have monitored tissue pressure in patient s treated with intramedullary nailing of tibial shaft fractures. A val ue of 30 mmHg has been used as the threshold for fasciotomy. The purpo se of this study was to evaluate this practice. Sixty-three patients w ere included in the series. Forty-three fractures were closed, 18 grad e I(Gustilo) and two grade II. Tissue pressure measurements were perfo rmed in 43 patients. Eighteen legs were treated with decompressive fas ciotomy, three on clinical findings alone, and 15 after measurement of a pressure higher than 30 mmHg. This gives a fasciotomy rate of 29%. At follow-up two patients were dead. All fractures were healed, and th ere were no major complications such as deep infection, extensive musc le necrosis, paresis or short-foot syndrome. Three fasciotomized patie nts had significantly reduced muscle strength compared with the contra lateral leg.