Osteofascial compartment pressure measurement in closed limb injuries - Whitesides' technique revisited

Abstract

Introduction: Regular monitoring of tissue compartmental pressures and hence a timely intervention in patients with impending compartment syndrome has been shown to prevent morbidity and permanent disability.

Material and methods: Intra-compartmental pressure in flexor compartment of forearm and various compartments of legs following recent trauma presenting within 6 h of injury was carried out in 30 subjects using Whitesides' technique and patients were classified into 3 categories for treatment purposes i.e., Category I: pressure <30 mmHg, Category II: pressure 30-40 mmHg and Category III: pressure >40 mmHg.

Results: Category I had 17 subjects, Category II had 6 subjects whereas 7 subjects fell into Category III. 6 patients out of the 30 studied needed fasciotomy, out of which 5 had fair or good result.

Conclusion: Whitesides' technique, though not much widely favoured, is a safe, inexpensive, easily assembled and reliable method for measurement of intra-compartmental pressure as a guide for decompression.

Keywords: Closed fracture in limbs; Compartment pressure; Compartment syndrome; Fasciotomy; Whitesides’ technique.

Figures

Fig. 1

Clinical photograph of left leg with impending compartment syndrome.

Fig. 2

X-ray picture of the same patient.

Fig. 3

Equipment required for using Whitesides’ technique for compartment pressure monitoring.

Fig. 4

Clinical photograph of Whitesides’ technique being used for compartment pressure monitoring.