This prospective clinical study sought to evaluate the possible effects of routine compartment pressure monitoring in tibial fractures and to assess the previously published criteria. Pressures in the anterior compartment were measured in consecutive cases of tibial fractures. In 95 patients, the protocol was completed with a follow-up after 1 yr. An optimal threshold pressure with both good sensitivity and specificity could not be identified. Such monitoring is a useful tool in the diagnosis of compartment syndrome, mainly in symptomatic patients or those who are difficult to assess, but routine monitoring and the use of most popular threshold pressures, which have low specificity, can result in overtreatment.