Monitoring of uncooperative, polytraumatized patients with tibial shaft fractures for acute compartment syndrome

BACKGROUND: The results of intracompartmental pressure monitoring were assessed in uncooperative, polytraumatized patients with tibial shaft fractures. METHODS: The study included 29 tibial fractures of 26 polytraumatized patients (9 females, 17 males; mean age 36 years; range 15 to 75 years) admitted to the intensive care unit. The fractures were on the right side in eight patients, on the left in 15 patients. Three patients had bilateral involvement. All the patients were unconscious. Following trauma, absolute compartment pressures and ?P (diastolic blood pressure – absolute compartment pressure) were monitored at 12-hour intervals for 72 hours via the intracompartmental pressure monitoring system. Patients whose ?P values were 30 mmHg or below underwent fasciotomy. The mean follow-up period was 21.2 months (range 18 to 25 months). RESULTS: The overall mean absolute compartment pressure was 30.25 mmHg, and the mean ?P was 48.47 mmHg at the end of 72 hours. Fasciotomy was performed in two patients (7%) in whom a diagnosis of acute compartment syndrome was made depending on ?P values less than 30 mmHg. None of the patients had complications associated with acute compartment syndrome. Union was achieved in all the patients without an additional intervention. The mean time to union was 5.21 months (range 3 to 9 months). CONCLUSION: Intracompartmental pressure monitoring should be considered for an early diagnosis of acute compartment syndrome in uncooperative, polytraumatized patients with tibial shaft fractures.

Tibia cisim kýrýklý, kooperasyon kurulamayan, politravmalý hastalar›n kompartman sendromu açýsýndan izlemi