The patient presented with a Tscherne type 2 tibial shaft fracture and developed skin blistering within an hour. In the operating room, compartment pressures were measured in all four compartments of the leg. The anterior compartment pressure was found to be 74 mmHg, which was more than 30 mmHg higher than the patient's diastolic blood pressure of 74 mmHg, indicating an anterior compartment syndrome. Fasciotomies were performed on the anterior and lateral compartments and the fracture was treated with an intramedullary nail. The posterior compartments did not develop compartment syndromes.

2. AP and lateral views of a Tscherne type 2 tibial shaft
fracture.

3. Within approximately one hour of presentation,
the patient’s skin began to blister.

4. A blood filled blister.

5. A clear blister.

6. The patient was brought to the operating room for treatment of his tibial
shaft fracture. On examination in the operating room, his leg felt
tense and he had pain on passive stretch of the anterior compartment
before being anesthetized.

7. Compartment pressures were therefore measured in all four
compartments. The area to be tested is cleaned with betadine.

8. There are multiple devices made for this technique. This
image shows one of them.

9. It is important that when using the device it is held parallel with the floor
so as not to adversely affect the measurement. This is also the case
when using other techniques, such as arterial line measurement, where
the transducer must be at the level of the examination.

10. The syringe is filled with fluid…

11. and then zeroed

12. Measuring compartment pressures using a location relatively close
to the fracture site has been demonstrated to give slightly more
accurate (increased) readings.

13. This is done whenever possible. The pressure in the anterior
musculature is taken first. After introducing the needle through
the fascia, the plunger is gently advanced to cause inflow of a
small amount of fluid and the pressure is allowed to equilibrate.

14. The patient had a diastolic pressure before induction of
anesthesia of 74mm of mercury. Thus a compartment
syndrome was diagnosed in the anterior compartment
(74 - 66 = 8).

15. ANTERIOR PRESSURE
MEASURED HERE
Pressure in the lateral compartment is measured next, just
posterior to the fibula. The pressure in the lateral
compartment was 45.

17. Next, compartment pressure in the posterior compartments
are measured by introducing the device just posterior to the
tibia medially, allowing measurement of first the superficial,
and by farther advancement, the deep compartment.

18. The posterior compartments did not have pressures
within 30mm Hg of the diastolic pressure and were
considered not to have developed compartment
syndromes, yet.

20. After anterior and lateral compartment fasciotomy, the patient
was treated with an unreamed, statically locked tibial nail. The
posterior compartments never developed compartment
syndromes.