Routine monitoring of compartment pressure in patients with tibial fractures: beware of overtreatment!

Janzing, H; Broos, Paul

doi:10.1016/s0020-1383(01)00005-5

Cited by 103 publications

(55 citation statements)

References 38 publications

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“…The use of a 12 h mean is, in our opinion, of no clinical value, because it is not appropriate to postpone the therapy until the 12-h or 24-h mean is known. The high number of positive tests (low specificity) was confirmed by our own study [61] that showed that the use of compartment pressure monitoring with use of all described threshold values would result in overtreatment.…”

Section: Compartment Pressure Monitoringmentioning

confidence: 67%

Epidemiology, Etiology, Pathophysiology and Diagnosis of the Acute Compartment Syndrome of the Extremity

Janzing

2007

Eur J Trauma Emerg Surg

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Due to an insult that causes a pressure elevation in the compartment, which is the limited space surrounded by the unyielding bone and fascia, the circulation is compromised resulting in muscular and neural ischemia and eventually tissue necrosis. The diagnosis of the compartment syndrome has always been based on the clinical symptoms, however, multiple studies suggested that clinical examination alone is insufficient and may result in delayed diagnosis, delayed treatment and serious sequelae. To avoid delayed diagnosis and treatment the use of compartment pressure monitoring has been advised. There is, however, no consensus about the indications for the compartment pressure monitoring, or about the threshold pressure that should be used for dermatofasciotomy. A diagnostic guideline is proposed.

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Section: Compartment Pressure Monitoringmentioning

confidence: 67%

Epidemiology, Etiology, Pathophysiology and Diagnosis of the Acute Compartment Syndrome of the Extremity

Janzing

2007

Eur J Trauma Emerg Surg

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“…Where the diagnosis is uncertain, manometry should be utilised to determine compartmental pressures. Although the intra-compartmental pressure can be measured directly, there is variation in what is considered as diagnostic [24]. A difference of 30 mmHg or less between the diastolic pressure and intra-compartmental pressure has been suggested as a more sensitive indicator of tissue perfusion pressure and has, therefore, been recommended as the threshold for fasciotomy [19,25].…”

Section: How Can a Diagnosis Be Made?mentioning

confidence: 99%

Clinical review: Volkmann’s ischaemic contracture

Pettitt

McArthur

2011

Eur J Trauma Emerg Surg

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Prevention is essential regarding Volkmann's ischaemic contracture. This can be achieved through careful observation of patients sustaining high-risk extremity injuries, notably, children with supracondylar fractures of the humerus, and immediate decompression if signs and symptoms of a compartment syndrome are present. Increased awareness amongst doctors of compartment syndrome is fundamental and will allow early recognition, clinical diagnosis and subsequent fasciotomy.

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“…Thus, direct measurements of intracompartmental pressure (ICP) has been advocated [1][2][3]. While impaired soft tissue elasticity is a pivotal finding [4][5][6][7][8], manual palpation to detect decreased elasticity has low sensitivity [9] when used alone. To ensure a highly reliable diagnosis, pressure measurement of suspected compartments is required [10][11][12].…”

Section: Introductionmentioning

confidence: 99%