The threshold for decompression in acute compartment syndrome is quoted as a pressure difference between the compartment and diastolic blood pressure of less than 30mmHg. This study reports the findings of continuous compartment pressure monitoring in children who underwent tibial osteotomies.

In this prospective observational study, twenty seven children who underwent tibial osteotomies had anterior compartment pressures monitored using a transducer-tipped probe for a minimum of 72 hours following surgery. Pressure data were collected hourly together with evidence of clinical signs, symptoms and patterns of analgesic use. Patients were also reviewed for late sequelae of compartment syndrome.

One case of compartment syndrome were encountered. Pressure differences (diastolic BP - compartment pressure) were found to vary widely, with many children exceeding the threshold for decompression but without manifesting other signs of compartment syndrome. Fasciotomies were not performed in view of the conflicting evidence and subsequent review confirmed the absence of late sequelae. In these children, low diastolic blood pressures were a common but normal feature. The prevalence of compartment syndrome was 3.7% (1/27). The positive predictive value of using the adult threshold was 7.1%; the negative predictive value was 100%.

We conclude that the threshold for decompression as applied to adults is unsuitable for use in children inasmuch as a positive result would lead to a correct diagnosis in only 7.1% of children. A negative test is more useful in correctly excluding compartment syndrome in 100% of the children studied.

Introduction

Advances in the management of open tibial fractures have reduced the incidence of long-term complications of these injuries. However, a number of patients continue to suffer from sequelae such as infection, non-union and malunion. Many orthopaedic surgeons believe a below-knee amputation with a well-fitted prosthesis is a better alternative to limb reconstruction surgery. There are few studies that evaluate the long-term functional outcomes of amputees against patients who have undergone limb salvage procedures, and their results are conflicting. The hypothesis of this study is that patients who have undergone limb salvage have as good or better outcomes than those who have had below-knee amputations.