Abstract
Introduction and Aims: To assess the effects of the various stages of intra-medullary (IM) nailing of the tibia upon intra-compartmental pressure (ICP) measurements, with particular emphasis on factors which reduce the pressure.
Method: Using sensitive transducer-tipped pressure monitors, the anterior compartment pressure was recorded throughout IM nailing of tibial shaft fractures in 34 consenting patients.
Results: Significant peaks in ICP, up to 140mmHg, occurred during reaming and nail insertion, with a sustained elevated pressure phase seen following nail insertion (p< 0.01). In those patients with no fracture distraction visible on fluoroscopy following nail insertion, this pressure was relieved by the release of traction (mean reduction 16.79mmHg, p< 0.01). However, in those with a visible fracture gap, traction release was not sufficient, and impaction of the fracture after distal cross-screw insertion was required to achieve baseline levels in this group (mean reduction 15.29mmHg; p< 0.01).
Conclusions: Using the various pressure criteria for diagnosing ACS, some of our patients either had, or were at considerable risk of developing ACS post-operatively. Furthermore, if fracture impaction had not been performed where necessary, the subsequent sustained increase in ICP would have resulted in additional patients fulfilling the diagnostic criteria for ACS. Clearly, this observation may explain the tendency for some distracted fractures to fail to unite as a result of ischaemia, but of greater significance is the potential for ACS to occur in the post-operative period, leading to significant long-term complications. We recommend that, if traction is used, it is released as early as possible following nail insertion, and that the fracture should be impacted following distal cross-screw insertion if there is visible distraction of the bone ends on fluoroscopy following nail insertion.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
