Abstract
Acute compartment syndrome is associated with tibial fractures and failure to diagnose it leads to grave consequences. This study was conceived with the aim of determining the intra-compartmental pressure in adults with closed tibial fractures and intended to provide early diagnosis of acute compartment syndrome. The Whitesides injection method was used, using hospital-available materials. The intra-compartmental pressure in the anterior and deep posterior compartments of 52 patients with closed tibial fractures was measured at presentation and 4 hourly for 24 h. In three patients, the pressure was very high, and the differential pressure (i.e. the difference between the diastolic blood pressure and the intra-compartmental pressure) was greater than 30 mmHg, which was diagnostic of acute compartment syndrome. They were all treated by fasciotomy. It is concluded that Whitesides method can be used to diagnose acute compartment syndrome. The apparatus is easy to set up, inexpensive and therefore ideal for use in our environment where sophisticated devices of tissue pressure measurement are not available.
Résumé
Le syndrome compartimental aigu, ou syndrome de loge, est associé avec les fractures tibiales et l’absence de son diagnostic a des conséquences graves. Cette étude a pour but de déterminer la tension intracompartimentale chez l’adulte présentant une fracture fermée du tibia pour pouvoir diagnostiquer précocement un syndrome de loge. Les tensions intracompartimentales dans les compartiments antérieurs et postérieurs profonds de 52 malades avec une fracture tibiale fermée ont été mesurées à l’admission puis toutes les quatre heures pendant 24 h. Nous avons utilisé la méthode de Whitesides avec piqûres en utilisant le matériel disponible dans l’hôpital. Chez trois malades la pression différentielle (c.-à-d. la différence entre la tension artérielle diastolique et la tension intracompartimentale) était ≤30 mmHg ce qui diagnostique le syndrome compartimental. Tous ont été traités par fasciotomie tibiale. Nous concluons que cette méthode de Whitesides peut être utilisée pour diagnostiquer le syndrome compartimental. L’appareil est facile à installer et bon marché et il est recommandé dans notre environnement où les appareils sophistiqués ne sont pas disponibles.
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Footnotes
An erratum to this article can be found at http://dx.doi.org/10.1007/s00264-005-0672-4
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