Skip to main content

Advertisement

SpringerLink
Log in

Effect of Intramedullary Nails in Tibial Shaft Fractures as a Factor in Raised Intracompartmental Pressures: a Clinical Study

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mubarak SJ, Hargens AR, Owen CA, Akeson WH. Muscle pressure measurement with the wick catheter. In: Goldsmith H, ed. Practice of surgery. New York: Harper & Row, 1978.

    Google Scholar 

  2. Rorabeck cH., Macnab I. The pathophysiology of the anterior tibial compartment syndrome. Clin Orthop Relat Res 1975;113:52–57.

    Article  PubMed  Google Scholar 

  3. Ashton H. The effect of increased tissue pressure in blood flow. Clin Orthop 1975;118:15.

    Google Scholar 

  4. Meyer SC, Mubarak SJ. Compartment syndromes. In: Chapman’s orthopaedic surgery, 3rd edn. Philadelphia: Lippincott Williams & Wilkins, 2000.

    Google Scholar 

  5. Ogunlusi JD, Oginni L. Normal leg compartmental pressures in adult Nigerians using the Whitesides method. Iowa Orthop J 2005;25:200–202.

    PubMed  Google Scholar 

  6. Mubarak SJ, Hargens AR. Compartment syndromes and Volkmann’s contractures. Philadelphia: WB Saunders, 1981:113.

    Google Scholar 

  7. Matsen FA III, Winquist RA, Krugmire RB. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am 1980;62:286.

    PubMed  Google Scholar 

  8. Whitesides TE Jr, Haney TC, Morimoto K, Hirada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 1975;113:43–51.

    Article  PubMed  Google Scholar 

  9. Whitesides TE, Heckmann MM. Acute compartment syndrome: update on diagnosis and treatment. JAAOS 1996;4:209–218.

    Google Scholar 

  10. Ellis H. Disabilities after tibial shaft fractures. J Bone Joint Surg 1958;40B:190–197.

    Google Scholar 

  11. Heppenstall RB, Sapega AA, Scott R et al. The compartment syndrome. An experimental and clinical study of muscular energy metabolism using phosphorus nuclear magnetic resonance spectroscopy. Clin Orthop 1988;226:138.

    PubMed  Google Scholar 

  12. Heppenstall B, McCombs P, DeLaurentis D. Vascular injuries and compartment syndromes. In: Rockwood CA, Green DP, eds. Fractures in adults, vol 11, 5th edn. Philadelphia: Lippincott Williams & Wilkins, 2001:332.

    Google Scholar 

  13. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. J Bone Joint Surg Br 1996;78:99.

    CAS  PubMed  Google Scholar 

  14. McQueen MM, Gaston P, Court-Brown cM. Acute compartment syndrome: who is at risk? J Bone Joint Surg Br 2000;82:200–203.

    Article  CAS  PubMed  Google Scholar 

  15. Moehring HD, Voigtlander JP. Compartment pressure monitoring during intramedullary fixation of tibial fractures. Orthopedics 1995;18:631–635.

    CAS  PubMed  Google Scholar 

  16. Hamza KN, Dunkerley GE, Murray CM. Fractures of the tibia. A report on fifty patients treated by intramedullary nailing. J Bone Joint Surg 1971;53-B:696–700.

    Google Scholar 

  17. Tischenko GJ, Goodman SB. Compartment syndrome after intramedullary nailing of the tibia. J Bone Joint Surg. 1990;72-A:41–44.

    Google Scholar 

  18. Moed SR, Strom DE. Compartment syndrome after closed intramedullary nailing of the tibia: a canine model and report of two cases. J Orthop Trauma 1991;5:71–77.

    CAS  PubMed  Google Scholar 

  19. Mawinney IN, Maggin P, McCoy GF. Tibial compartment syndrome after tibial nailing. J Orthop Trauma 1994;8:212–214.

    Article  Google Scholar 

  20. McQueen MM, Christie J, Court Brown CM. Compartment pressure after intramedullary nailing of the tibia. J Bone Joint Surg 1990;72B:395–397.

    Google Scholar 

  21. Nassif JM, Gorczyca JT, Cole JK et al. Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures: a randomized prospective study. J Orthop Trauma 2000;14:554–558.

    Article  CAS  PubMed  Google Scholar 

  22. Janzing HM, Broos PL. Routine monitoring of compartment syndrome in patients with tibial fractures: beware of over-treatment! Injury 2001;32:415–421.

    Article  CAS  PubMed  Google Scholar 

  23. Tornetta P, French BG. Compartment pressures during nonreamed tibial nailing without traction. J Orthop Trauma 1997;11:24–27.

    Article  PubMed  Google Scholar 

  24. Hak DJ, Johnson EE. The use of unreamed nail in tibial fractures with concomitant preoperative or intraoperative elevated compartment pressure or compartment syndrome. J Orthop Trauma 1994;8:203–211.

    Article  CAS  PubMed  Google Scholar 

  25. Kutty S, Laing AJ, Prasad CV, McCabe JP. The effect of traction on compartment pressures during intramedullary nailing of tibial shaft fractures. A prospective randomised trial. Int Orthop 2005;29:186–190.

    Article  PubMed  Google Scholar 

  26. Nassif JM, Gorczyca JT, Cole JK, Pugh JK, Pienkowski D. Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures: a randomized prospective study. J Orthop Trauma 2000;14:554–558.

    Article  CAS  PubMed  Google Scholar 

  27. Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. BJA Adv Br J Anaesth 2009;102:3–11.

    Article  CAS  Google Scholar 

  28. Matsen FA III. Compartment syndromes. Part A. Pathophysiology of compartments syndromes. In: Instructional Course Lectures, The American Academy of Orthopaedic Surgeons, vol 38. Illinois: Park Ridge, 1989:463–466.

    Google Scholar 

  29. Heckman MM, Whitesides TE, Grewe SR, Rooks MD. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Joint Surg 1994;76:1285–1292.

    CAS  PubMed  Google Scholar 

  30. Tornetta P III, Templeman D. Instructional Course Lectures, The American Academy of Orthopaedic Surgeons. Compartment syndrome associated with tibial fracture. J Bone Joint Surg 1996;78:1438–1444.

    Google Scholar 

  31. McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg 1996;78-B:95–98.

    Google Scholar 

  32. Suk M, Norvell DC, Hanson B, Dettori J, Helfet D. Orthopaedic surgery based on evidence: what is the evidence without results evaluation? JAAOS 2008;7:205–211 (Spanish edition).

    Google Scholar 

  33. Koval KJ, Clapper MF, Brumback RJ, Ellison PS Jr, Poka A, Bathon GH, Burgess AR. Complications of reamed intramedullary nailing of the tibia. J Orthop Trauma 1991;5:184–189.

    CAS  PubMed  Google Scholar 

  34. White TO, Howell GE, Will EM, Court-Brown CM, McQueen MM. Elevated intramuscular compartment pressures do not influence outcome after tibial fracture. J Trauma 2003;55:1133–1138.

    Article  PubMed  Google Scholar 

  35. McQueen MM, Christie J, Court-Brown CM. Compartment pressures after intramedullary nailing of the tibia. J Bone Joint Surg 1990;72-B:395–397.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopedic and Trauma Unit, Nostra Senyora de Meritxell Hospital, Escaldes, Principality of Andorra

    Jose I. Torrero

  2. Department of Anesthesiology, Nostra Senyora de Meritxell Hospital, La Massana, Principality of Andorra

    Francesc Aroles

  3. Nostra Senyora de Meritxell Hospital, Escaldes, Principality of Andorra

    Jose I. Torrero

Authors
  1. Jose I. Torrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesc Aroles
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jose I. Torrero.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Torrero, J.I., Aroles, F. Effect of Intramedullary Nails in Tibial Shaft Fractures as a Factor in Raised Intracompartmental Pressures: a Clinical Study. Eur J Trauma 35, 553–561 (2009). https://doi.org/10.1007/s00068-009-9097-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-009-9097-x

Key Words

Search

Navigation