We read your editorial on ‘Early diagnosis of compartment syndrome: Continuous pressure measurement or not?’
1with interest and not a little trepidation for the management of future patients in the NHS. Your message is that ICP monitoring is unnecessary. However we feel that we should point out that there is evidence that the traditional clinical signs of compartment syndrome are at best often difficult to interpret. Ulmer, in his analysis of the usefulness of these signs, showed that the classical clinical signs had a sensitivity of 13–19% and a positive predictive value of only 11–15%.
- Giannoudis P.V.
- Tzioupis C.
- Pape H.-C.
Early diagnosis of tibial compartment syndrome: continuous pressure measurement or not?.
Injury. 2009; 40: 341-342
2The editorial mentions that Ulmer stated that if three clinical signs were present the probability of a compartment syndrome was 93%. However it did not state that one of the clinical signs was paralysis which, if allowed to develop, precludes full recovery! If one relies on clinical signs one must be very careful about underdiagnosing compartment syndrome.
- Ulmer T.
The clinical diagnosis of compartment disorder of the lower leg: are clinical findings predictive of the disorder?.
J Orthop Trauma. 2002; 16: 572-577
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- Early diagnosis of tibial compartment syndrome: continuous pressure measurement or not?.Injury. 2009; 40: 341-342
- The clinical diagnosis of compartment disorder of the lower leg: are clinical findings predictive of the disorder?.J Orthop Trauma. 2002; 16: 572-577
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.