Intracompartmental pressure measurement is a painful procedure and is not well tolerated by most children in the ward setting. It may be used as an adjunctive exam under anesthesia or in an unconscious child in the ICU setting.
When compartment syndrome is clinically obvious, there is usually no benefit from measuring pressures and immediate dermato-fasciotomy should be undertaken.
When the diagnosis is unclear, compartment pressure measurement may be confirmatory, or prevent unnecessary dermato-fasciotomy.
Various techniques are available to measure the intracompartmental tissue pressure.
All trauma surgeons should adopt a technique that is available and familiar. This may involve use of a commercially available compartmental pressure device, a mercury manometer, large-bore needle and connecting tubing (after Whitesides), or an electronic strain gauge used for physiologic monitoring in ICU, or the OR.
In the absence of quantitative evidence of the normal muscle perfusion pressure in children, the comparison between the involved compartment and the corresponding pressure in the uninvolved compartment, in combination with whatever clinical information is available, can inform the surgeon who is responsible for making the decision whether or not to perform a dermato-fasciotomy.
The consequence for the child for failing to perform a dermato-fasciotomy in the presence of a compartment syndrome is a gross functional deficit.
The consequence for the child of performing a dermato-fasciotomy, which subsequently proved to be unnecessary, is a surgical scar. This observation must also inform the decision making.
If the necessary equipment is not available for direct pressure measurement, then the diagnosis must be assumed if there is reasonable clinical suspicion.