Compartment syndrome is confirmed in a 19-year-old after closed tibial fracture. Intracompartment pressure is 42 mmHg and diastolic blood pressure is 70 mmHg. The critical pressure differential (delta-P) that mandates fasciotomy is:

• A Absolute compartment pressure > 30 mmHg irrespective of blood pressure
• B Compartment pressure > 40 mmHg irrespective of other parameters
• C Delta-P < 20 mmHg
• D Delta-P (diastolic BP minus compartment pressure) < 30 mmHg ✓

Explanation

The most reliable threshold for fasciotomy is delta-P < 30 mmHg (diastolic BP − compartment pressure). In this patient, delta-P = 70 − 42 = 28 mmHg, which is below 30 mmHg, mandating immediate fasciotomy. Using absolute compartment pressure alone (> 30 mmHg threshold) over-treats hypotensive patients; using > 40 mmHg under-treats them. Delta-P accounts for perfusion pressure and is the current standard in Whitesides' criteria.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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