Monitoring antebrachial compartmental pressure in displaced supracondylar elbow fractures in children

• Published in: Journal of pediatric orthopaedics. B Vol. 13; no. 6; pp. 412 - 416
• Main Authors: Carbonell, Pedro Gutiérrez, Prats, Fernando López, Fernández, Pedro Doménech, Valiente Valero, Jose Manuel, Sastre, Sigfrido
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-11-2004
• Subjects: Blood Pressure - physiology; Child, Preschool; Compartment Syndromes - etiology; Compartment Syndromes - prevention & control; Female; Humans; Humeral Fractures - complications; Humeral Fractures - surgery; Male; Monitoring, Physiologic - instrumentation; Postoperative Period; Pressure; Prospective Studies; Sphygmomanometers; Transducers
• ISSN: 1060-152X; 1473-5865
• DOI: 10.1097/01202412-200411000-00013

PURPOSEOur aim was to measure antebrachial volar compartment pressure in displaced supracondylar elbow fractures in children.
METHODSWe conducted a prospective, observational study of 42 fractures. The mean age was 5.2 years. There was type II displacement in nine cases (21.4%) and type III in 33 (78.6%). A wick catheter (1.5 mm in diameter) was placed perioperatively and compartmental pressure was monitored on a intra-compartmental pressure monitor system (STIC monitor) with a ±1 mmHg margin of error. Compartmental, systolic and diastolic pressures were measured every day for the first three postoperative days and then for a 2-week follow-up period. Descriptive statistics, t-test and correlation with a P<0.05 significance were studied.
RESULTSMean compartmental pressure before reduction was 8.3 mmHg and 6.7, 4, 2.4, 1.7 and 1 mmHg during the first 3 days and at 1 and 2 weeks post-reduction, respectively. Pressure decreased 40% (P=0.0005) from the first to the second day and 75% (P=0.0005) from the first day to the first week. There was no correlation between compartmental pressure and systolic and diastolic pressure. The compartmental pressure decreased significantly by the third postoperative day (P=0.02).
CONCLUSIONCompartmental pressure decreased 60% the first 3 days. In displaced supracondylar fractures with clinical risk factors, it is advisable to monitor compartmental pressure during the first 24–48 h.