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Children's Orthopaedics: J. M. Staudt, M. J. C. Smeulders, and C. M. A. M. van der Horst Normal compartment pressures of the lower leg in children J Bone Joint Surg Br 2008; 90-B: 215-219 [Abstract] [Full text] [PDF]

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Whitesides Technique

Michael R Barnes   (10 April 2008)

Normal compartment pressures of the lower leg in children

John A Schlechter, DO, Scott J. Mubarak, MD   (21 February 2008)

Whitesides Technique 10 April 2008
Michael R Barnes, Clinical Scientist Dept of Sports Medicine, Leicester General Hospital, UK Send letter to journal: Re: Whitesides Technique mike.barnes{at}uhl-tr.nhs.uk Michael R Barnes	Sir, I found this to be a very interesting paper which has added some very useful baseline data for compartment pressures in children. However, I am somewhat confused by the references to Whitesides et al,1 and the actual methods used to measure the pressures. The technique described by Whitesides et al in 1975 and re-evaluated by Boody and Wongworawat2 in 2005, is not just a simple technique of using a needle, but involves a complicated system employing pressure lines, sphygmomanometer, a 20 ml syringe and a 3-way stopcock, and monitoring the movement of an air-saline meniscus. This is clearly illustrated in the original paper as well as being described in detail in seven steps. The “Whitesides Technique” has been globally accepted for over 30 years as a very specific method, not simply shorthand for using a needle. It seems unlikely that this is the technique that the authors would have adopted for their study as it is time-consuming and takes a great deal of care to produce valid results. Its great advantage is that it uses readily available and very inexpensive components. The authors have gone into great detail and have been very thorough about other aspects of their methodology, but since this paper is about pressure measurements, it is important to know the exact details of the techniques and equipment used, rather than an erroneous reference to the seminal 1975 paper by Whitesides. M.R. Barnes, Clinical Scientist, Dept of Sports Medicine, Leicester General Hospital, Leicester, UK. 1. Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 1975;113:43-51. 2. Boody AR, Wongworawat MD. Accuracy in the measurement of compartment pressures: a comparison of three commonly used devices. J Bone Joint Surg [Am] 2005;87-A:2415-22.
Normal compartment pressures of the lower leg in children 21 February 2008
John A Schlechter, DO, Fellow Pediatric Orthopedic Surgery Rady Children's Hospital San Diego, Scott J. Mubarak, MD Send letter to journal: Re: Normal compartment pressures of the lower leg in children john_schlechter{at}yahoo.com John A Schlechter, DO, et al.	Sir, We read this article with interest. Several concerns arose during our reading and review of this paper. The authors concluded that needle manometry can be performed using small needles and that the addition of a side-port is unnecessary, and cite the 2005 publication of Boody and Wongworawat1 in their discussion. The authors have incorrectly referenced this publication when they stated that needles of different lengths and port configurations were tested and that the conclusion was that simple needle manometry is the most reliable method of accurate measurement of compartment pressure. Upon reviewing the materials and methods of Boody and Wongworawat the diameter and length of the needles used in their study did not vary. Three configurations were tested, an 18-gauge straight needle, an 18-gauge side-port needle and a slit catheter. They concluded (contrary to the statements made by Staudt et al) that side-port needles and slit catheters were more accurate than straight needles. The use of the term single-port needle in the study by Staudt et al is somewhat ambiguous. Is this a side-port needle or a straight hypodermic needle with a single aperture? The use of a straight needle has been shown to overestimate the measurement of intracompartmental pressures1,2 where the use of a wick catheter3 provides a more extensive contact area for fluid equilibrium, preventing ball-valve obstruction of the needle.4 Resting muscle pressures measured using a slit catheter have been reported in a range from 0 to 4 mmHg5 in an adult population. We believe that the measurements reported by Staudt et al are erroneously high secondary to the technique and equipment used, and fear that the data published in this article may be misleading to the orthopaedic community. If a more accurate device was used their data would certainly be different. J.A. Schlechter, DO, S.J. Mubarak, MD, Rady Children’s Hospital San Diego, San Diego, California, USA. 1. Boody AR, Wongworawat MD. Accuracy in the measurement of compartment pressures: a comparison of three commonly used devices. J Bone Joint Surg [Am] 2005;87-A:2415-22. 2. Moed BR, Thorderson PK. Measurement of intracompartmental pressure: a comparison of the slit catheter, side-ported needle, and simple needle. J Bone Joint Surg [Am] 1993;75-A:231-5. 3. Scholander PF, Hargens AR, Miller SL. Negative pressure in the interstitial fluid of animals. Fluid tensions are spectacular in plants; in animals they are elusively small, but just as vital. Science 1968;161:321-8. 4. Mubarak SJ, Owen CA, Hargens AR, Garetto LP, Akeson WH. Acute compartment syndromes: diagnosis and treatment with the aid of the wick catheter. J Bone Joint Surg [Am] 1978;60-A:1091-5. 5. Meyer RS, White KK, Smith JM, et al. Intramuscular and blood pressures in legs positioned in the hemilithotomy position: clarification of risk factors for well-leg acute compartment syndrome. J Bone Joint Surg [Am] 2002;84-A:1829-35.