Three patients had compartment syndrome of the leg after tibial
intramedullary nailing with reaming. They were all treated successfully
with emergency fasciotomy. A prospective study was done of seven additional
patients who had continual monitoring of the pressure in the deep posterior
compartment during tibial intramedullary nailing with reaming. In five of
them, the procedure was performed three weeks or less after injury and in
the remaining two, the nailing was performed later for the treatment of
non-union. Two pressure peaks in the deep posterior compartment were noted:
one after strong longitudinal traction was applied and the fracture was
reduced and the other during intramedullary reaming. Intraoperative
pressure of thirty millimeters of mercury or more were recorded in three of
the seven patients. In the treatment of tibial fractures, operative
procedures that involve forceful traction for a long time may predispose
the patient to compartment syndrome in the leg. Close clinical observation
of such patients is needed. When there is a high risk of compartment
syndrome, monitoring of the pressure in the compartment may be prudent.