This 1996 retrospective cohort from Edinburgh compared outcomes in 25 patients with tibial diaphyseal fractures complicated by ACS. Thirteen patients had early continuous compartment pressure monitoring; 12 did not. The study asks whether continuous monitoring changes the timing of fasciotomy and, ultimately, functional outcomes.
A young patient comes in at midnight with a tibial shaft fracture after a football injury. The orthopedic team debates whether to monitor or just watch clinically. This paper answers that question directly. Patients managed without early continuous monitoring had a 91% rate of permanent sequelae. Those with early monitoring had zero. The difference was not injury severity — it was detection speed.
When you have a tibial fracture in a patient aged 35 or younger (7% ACS risk), place a slit catheter in the anterior compartment and monitor continuously. Do not wait for clinical signs. Pain is unreliable, and by the time a motor deficit appears, full recovery is rare.
The delta pressure threshold used here is diastolic BP minus compartment pressure less than 30 mmHg. This is the decompression trigger, and it remains a core board concept. If monitoring is not available, decompress all four compartments rather than risk missing the deep posterior compartment.
This 1996 retrospective cohort from Edinburgh compared outcomes in 25 patients with tibial diaphyseal fractures complicated by ACS. Thirteen patients had early continuous compartment pressure monitoring; 12 did not. The study asks whether continuous monitoring changes the timing of fasciotomy and, ultimately, functional outcomes.
A young patient comes in at midnight with a tibial shaft fracture after a football injury. The orthopedic team debates whether to monitor or just watch clinically. This paper answers that question directly. Patients managed without early continuous monitoring had a 91% rate of permanent sequelae. Those with early monitoring had zero. The difference was not injury severity — it was detection speed.
When you have a tibial fracture in a patient aged 35 or younger (7% ACS risk), place a slit catheter in the anterior compartment and monitor continuously. Do not wait for clinical signs. Pain is unreliable, and by the time a motor deficit appears, full recovery is rare.
The delta pressure threshold used here is diastolic BP minus compartment pressure less than 30 mmHg. This is the decompression trigger, and it remains a core board concept. If monitoring is not available, decompress all four compartments rather than risk missing the deep posterior compartment.