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.
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.
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.
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.
General trauma-Lower limb injuries-Lower extremity trauma-Fractures-Intramedullary nailing of long bones
European Journal of Trauma and Emergency Surgery 04/2012; 35(6):553-561. · 0.33 Impact Factor