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Three Part Question

In [a patient with suspected lower limb compartment syndrome] does [the distance of a compartment monitoring device from the fracture site] affect [the measured compartment pressure]?

Clinical Scenario

A 29-year-old man presents to the emergency department after sustaining a mid-shaft spiral closed tibial fracture in a motorcycling crash. You know he is at high risk of developing compartment syndrome and requires compartment monitoring. You wonder whether the distance of the compartment monitoring device from the fracture site affects the pressure reading and therefore the accuracy of the diagnosis of compartment syndrome.

Search Strategy

Ovid MEDLINE(R) 1950 to August Week 3 2010

(exp Compartment Syndromes/OR compartment pressure.mp. OR compartment syndrome.mp.) AND (measure$.mp OR monitor$.mp. OR evaluat$.mp.) AND (exp tibial fractures/). Limit to human and English language.

PubMed via the US National Library of Medicine 09/09/2010: compartment pressure (title).

Search Outcome

84+69 papers, respectively, found, of which two were of sufficient quality for inclusion. These are summarised in the table

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Saikia et al, 2008, India	75 consecutive patients with closed fractures of the lower leg presenting within 6 h of injury. Measurement of anterior compartment pressure at level of the fracture, 5 cm and 10 cm away using Whitesides’ technique.	Observational	Mean anterior compartment pressures (mm Hg):	At fracture site 31.47 5cm from fracture 17.07 10cm from fracture 3.41 p<0.001	Only 1 compartment measured
Heckman et al, 1994, USA	25 consecutive patients with closed tibial fracture. Tissue pressure measured at the level of the fracture and at 5 cm increments in 94 compartments using Whitesides’ technique or with a solid-state transducer intracompartmental pressure monitoring system (Stryker).	Observational	Highest compartment pressure :	At fracture site 89% 5 cm distal 5% 5 cm proximal 2% 10 cm proximal 3% p<0.0005	Small study.

Comment(s)

Heckman et al studied 25 patients with closed tibial fractures and measured compartment pressures at the level of the fracture and then 5 cm increments proximal and distal to the fracture. Measured pressured dropped by nearly 10 mm Hg per 5 cm from the fracture site. This was echoed in the Saikia et al.

Clinical Bottom Line

In suspected compartment syndrome, the pressure should be measured as close to the fracture site as is practicable.

References

1. Saikia KC, Bhattacharya TD, Agarwala V. Anterior compartment pressure measurement in closed fractures of leg. Indian J Orthop 2008;42:217–21.
2. Heckman MM, Whitesides TE Jr, Grewe SR, et al. Compartment Pressure in Association with Closed Tibial Fractures. J Bone Joint Surg Am 1994;76:1285-1292.