Background
The diagnosis of acute compartment syndrome can be very difficult to make in a injured patient who already has significant pain and swelling, for example, from a double bone forearm fractures. Compartment pressure monitoring was developed to assist the surgeon who is attempting to make an accurate diagnosis of compartment syndrome in an emergency situation.
History Overview
The residual contracture and necrosis associated with untreated compartment syndrome was initially described by Volkmann in 1881.1 It was decades later when the first fasciotomy was performed to decomparess an acute compartment syndrome. 3-3 In the 1970's the pathophysiology and the potential to measure compartment pressures in trauma patients was studied by Rorabeck3, Whitesides4 and others.1
Description
If a diagnosis of compartment syndrome can not be made clinically, for example an intoxicated patient who can not cooperate with a physical examination, then measuring the compartment pressure with a compartment pressure monitor is indicated to confirm or eliminate the diagnosis. When the examiner uses the Whitesides method, a compartment syndrome diagnosis is confirmed when the compartment pressure is with 30mmHg to the mean arterial pressure or 20 mmHg below the diastolic blood pressure. Some surgeons feel surgery is indicated when the compartment pressure is ≥30 mmHg. There is no consensus on what pressure readings are absolutely diagnostic of a compartment syndrome. Sometimes the best the examiner can do is compare the pressure in the injured forearm to the same compartment in the uninjured forearm.1,2.
