Compartment Syndrome — Current Trends in Scottish Practice

Abstract

The results are reported of a postal survey into current trends in the management of compartment syndrome and the use of compartment pressure monitoring (CPM) within Scottish trauma units. The majority of consultants in the study felt that all patients, especially the obtunded, with suspected compartment syndrome should be diagnosed using a combination of clinical review and CPM. 73% had CPM devices available representing an increase of 27% compared with previously published UK data. 43% improvised a device using a standard CVP/Arterial-line, transducer and monitor. Marked variation in threshold pressure was noted with the majority recommending perfusion pressure (PP) of diastolic blood pressure (DBP)--intracompartmental pressure (ICP) < 30 mmHg for intervention. We have found no published evidence to suggest that CPM in itself is harmful. Although a marked variation in intervention threshold exists in the literature, we would support a perfusion pressure of < 30 mmHg as being a safe, familiar and conservative intervention threshold, particularly when used in conjunction with clinical assessment.

Thigh Compartment Syndrome: Return to Competitive Sport is Possible

“…Diagnostic clinical symptoms include thigh pain out of proportion to severity of injury (most consistent), swollen tense thigh with increased circumference, pain with passive stretch, weakness of involved thigh muscle, and sensory or motor deficits in the anatomic distribution of the nerves contained in the involved compartment 4,5,7,10,11 . Repeated examinations are recommended.…”

“…Creatine-phosphokinase levels also reflect the amount of muscular damage. In obtunded patients direct measurement of intracompartmental pressure may be the only reliable means of confirming compartment syndrome 5,7,11 hours is associated with a poor outcome 5 .…”

Compartmental pressure in adults with tibial fracture

“…Compartmental pressure can be measured by the Whitesides injection technique; however, its limitation is that it gives a reading at one instant and is therefore unsuitable for continuous intra-compartmental pressure monitoring. Seventeen percent of practising orthopaedic trauma consultants in Scotland applied this method to monitor the pressure in patients vulnerable to compartment syndrome in a study done by Vassalos et al [21]. The beauty of the Whitesides injection technique is that it uses materials that are easily available in most hospitals.…”