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Case Report: S. Namboothiri Compartment syndrome and systemic hypertension J Bone Joint Surg Br 2005; 87-B: 1420-1422 [Abstract] [Full text] [PDF]

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Sreedharan P E Namboothiri   (11 January 2006)

Hypertension in compartment syndrome

Harish V Kurup, Preethy Nath   (26 October 2005)

Author's reply: 11 January 2006
Sreedharan P E Namboothiri Send letter to journal: Re: Author's reply: sreedharan_namboothiri{at}yahoo.co.in Sreedharan P E Namboothiri	Sir, I am extremely thankful to you for your keen interest in my article. I have used the needle manometer technique adviced by Whitesides1 but have never taken a decision based on it. In the cases reported, the clinical diagnosis was obvious. Muscle in the posterior part of the arm also bulged out. There is a lot of controversy regarding measuring compartment pressure. In a recent study from the UK,2 less than half of the surgeons had access to some form of compartment-pressure measuring device and only one fifth had a device specifically designed for compartment pressure measurement. Only one third of those who had a device used it routinely. That the compartment pressure measurement does not reflect the true picture of perfusion in the compartment is increasingly accepted.3,4 The real measure of tissue perfusion in compartment syndrome is yet to be established.3 The differential pressure suggested by Whitesides is currently relied upon for deciding whether to undertake fasciotomy. My aim was to draw attention to the fact that in a patient with compartment syndrome, the blood pressure itself may be rapidly changing, and to wait indefinitely could be catastrophic. Contrary to the general belief,5 hypertension can be detrimental in a patient with compartment syndrome as it leads to more bleeding into the compartment. Hypertension itself can be a predisposing factor. S Namboothiri 1. Whitesides TE Jr, Heckman MM. Acute compartment syndrome:update on diagnosis and treatment. J Am Acad Orthop Surg 1996;4:209-18. 2. Williams PR, Russel ID, Mintowt-Czyz WJ. Compartment pressure monitoring-current UK orthopaedic practice. Injury 1998;29:229-32. 3. Elliot KGB,Johnstone AJ. Review article. Diagnosing acute compartment syndrome. J Bone Joint Surg [Br] 2003;85-B:625-32. 4. Hargans AR,Mubarak SJ. Current concepts in the pathophysiology, evaluation and diagnosis of compartment syndrome. Hand Clin. 1998;14:371-83. 5. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome: who is at risk?. J Bone Joint Surg [Br] 2000;82-B:200-3.
Hypertension in compartment syndrome 26 October 2005
Harish V Kurup, Specialist Registrar in Orthopaedics Ysbyty Gwynedd, Bangor, North Wales., Preethy Nath Send letter to journal: Re: Hypertension in compartment syndrome harishvk{at}yahoo.com Harish V Kurup, et al.	Sir, We read with great interest the case report Compartment syndrome and systemic hypertension. We have few queries on the article for the author: 1. Did you have access to a compartment pressure measuring device or did you refrain from measuring it because of strong clinical suspicion? (We know that these are not readily available in many parts of world) 2. In case no.1, did the muscles in posterior compartment bulge out at the time of surgery? It has been shown that increase in pressure in one compartment can cause a similar response in the neighbouring compartment.1 3. Did you want to highlight the point that the body is trying to compensate the ischaemia by a hypertensive response (thereby increasing the gradient and perfusing the compartment) or were you just suggesting an association? The message was not clear from your report. If the former is the case, hypertension may be associated with every case of compartment syndrome and we should not be relying on pressure measurements. Harish V Kurup Specialist Registrar in Orthopaedics Ysbyty Gwynedd Bangor, North Wales LL57 2PW Dr. Preethy Nath SHO in Medicine. References: 1. Seel EH, Wijesinghe LD, O'Connor D. Experimental evaluation of the effect of raised pressure in a single compartment in the lower leg on neighbouring compartments using fresh above knee amputated legs-a study of interstitial pressures with two case reports. Injury 2005;36:1113-20.