A 45-year-old with a tibial fracture develops progressive compartment syndrome. Intracompartmental pressure is measured at 42 mmHg in a patient with a diastolic blood pressure of 70 mmHg. The threshold for fasciotomy based on delta pressure (ΔP = diastolic BP − compartment pressure) is:

• A ΔP < 10 mmHg, indicating emergent fasciotomy
• B ΔP < 20 mmHg (70 − 42 = 28 mmHg), so fasciotomy is not yet required
• C An absolute compartment pressure of >30 mmHg regardless of blood pressure mandates fasciotomy
• D ΔP < 30 mmHg, indicating fasciotomy is indicated (28 mmHg < 30 mmHg threshold) ✓

Explanation

The Whitesides/Mubarak criterion for fasciotomy is delta pressure (ΔP) < 30 mmHg, where ΔP = diastolic BP − compartment pressure. In this patient: ΔP = 70 − 42 = 28 mmHg, which is below the 30 mmHg threshold, indicating ischaemia and the need for immediate four-compartment fasciotomy. An absolute threshold of >30 mmHg is less reliable because it ignores perfusion pressure. ΔP <10 would represent a catastrophic situation; the 30 mmHg threshold is the accepted clinical guideline.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.