Quantitative measurement of intra-compartmental pressure of the leg in acute traumatic injury: As a routine trend

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 do play role, but quantification of compartment pressure reading serves as confirmation and determines the need of 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 over a 3 year period (Jan 09 to June 2012) presenting to our trauma center. Variables reviewed included intra-compartmental pressure readings and location of the fracture, development of subsequent compartment syndrome requiring fasciotomy. Patients were divided in to 1) Group A-proximal tibial fracture. 2) Group B- diaphyseal fracture. 3) Group C- pilon fracture. Values of the injured and uninjured leg were taken and the data analysed using spss version 22. Results: 168 (41 female, 127 male) cases were analysed. 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 mmHg (group B), 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 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.