A RAPID AND CONVENIENT METHOD FOR DETERMINING LIMB COMPARTMENT PRESSURE

2011 ◽  
Vol 23 (06) ◽  
pp. 435-444
Author(s):  
William Chu ◽  
Jiun-Hung Lin ◽  
Shih-Tsang Tang ◽  
Woei-Chyn Chu ◽  
Shuenn-Tsong Young ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Convenient Method ◽  
Strong Correlation ◽  
Cell Damage ◽  
Measurement Instrument ◽  
Critical Value ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
Wall Displacement ◽  
Cells Death

Compartment syndrome (CS) is the pressure increasing within a confined anatomic space, which results in ischemia to the encompassed tissues and then leads to cells death. If left untreated, CS results in irreversible cell damage, further permanently postischemic scarring and contracture. The intracompartmental pressure is a major diagnostic consideration. Various methods of compartment pressure (CP) measurement have been developed since the late 1800s. They can be classified into invasive and noninvasive categories. Invasive methods are accurate but painful; whereas noninvasive approaches are more comfortable but less accurate. Both methods provide reproducible outcomes but also require specific CP measurement instrument to be performed. This research proposes a rapid and convenient method via examining ultrasonographic fascia wall displacement. For the viscoelastic nature of the compartment fascia, our experiment results have shown the ultrasonographic fascia displacement accurately reflects even small changes of the compartment diameter. There is a strong correlation between compartment pressure and fascia displacement ratio. It also recommends that the ratio of 1.4 could be chosen as the critical value for determining acute compartment syndrome. These results suggest that ultrasonography may serve as an adequate noninvasive tool to monitor CP variations.

scholarly journals Compartment pressure changes after closed fractures of tibia

2016 ◽  
Vol 2 (3) ◽  
pp. 188
Author(s):  
Manju G. Pillai
Keyword(s):  
Compartment Syndrome ◽  
Great Majority ◽  
Signs And Symptoms ◽  
Definitive Treatment ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
College Hospital ◽  
Medical College ◽  
Closed Fractures ◽  
Upper Third

<p><strong>Background: </strong>Compartment syndrome is a potentially devastating situation. Raised intracompartmental pressure has been implicated as the primary pathogenic factor in compartment syndrome. The purpose of the study was early detection of compartment syndrome and corroborating the findings with other physical signs and symptoms, to prevent the onset of ischaemia and subsequent tissue changes that lead to crippling deformities.</p><p><strong>Methods:</strong> The present study was conducted in the Department of Orthopaedics, Pushpagiri medical college hospital, Thiruvalla over a period of 12 months.  Closed fractures of tibia admitted to the casualty unit within 36 hours of injury were selected for the study. A total of 24 patients were included with the majority in the age group of 31– 45 years. Whitesides technique was used to measure the compartment pressure. A differential pressure of less than 30 mm Hg was taken as the criterion for diagnosis of compartment syndrome. </p><p><strong>Results:</strong> The present study included 24 patients with affected 25 limbs.15 out of 25 limbs were with lower third fractures (60%) followed by upper third 6 (24%) and middle third 4 (16%). Out of 25 limbs 20 cases (80%) had associated fracture of fibula and 5 (20%) were not associated. In this study, out of 32% cases with increased compartment pressure, one case with upper third fracture (above 45 mm Hg) and one of the case with middle third fracture (20-30 mm Hg) with associated fibula had underwent immediate fasciotomy.</p><strong>Conclusion:</strong> Compartment pressure measurement is a very good index for predicting and preventing compartment syndrome. Fasciotomy to fully decompress all involved compartments is the definitive treatment for compartment syndrome in the great majority of cases. Delays in performing fasciotomy increase morbidity.

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot

2019 ◽  
Vol 40 (7) ◽  
pp. 853-858
Author(s):  
Reuben Lufrano ◽  
Matt Nies ◽  
Beau Ebben ◽  
Scott Hetzel ◽  
Robert V. O’Toole ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Primary Outcome ◽  
Acute Compartment Syndrome ◽  
Soft Tissue Coverage ◽  
Pressure Measurements ◽  
Compartment Pressure ◽  
Intracompartmental Pressure ◽  
Fresh Frozen ◽  
Compartment Pressures ◽  
Theoretical Risk

Background: Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression. Methods: Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies. Results: Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005). Conclusion: Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments. Clinical Relevance: The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.

scholarly journals Factors Predicting Lower Leg Chronic Exertional Compartment Syndrome in a Large Population

2017 ◽  
Vol 39 (01) ◽  
pp. 58-66 ◽  
Author(s):  
Johan de Bruijn ◽  
Aniek van Zantvoort ◽  
David van Klaveren ◽  
Michiel Winkes ◽  
Marike van der Cruijsen-Raaijmakers ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Predictive Model ◽  
Pressure Measurement ◽  
Large Population ◽  
Lower Leg ◽  
Leg Pain ◽  
Intracompartmental Pressure ◽  
Discriminative Ability ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome

AbstractKnowledge about lower leg chronic exertional compartment syndrome (CECS) is largely obtained from highly selected populations. Patient characteristics may therefore not be appropriate for the general population. Our purpose was to describe a heterogeneous population of individuals suspected of lower leg CECS and to identify predictors of CECS. Charts of individuals who were analyzed for exercise-induced lower leg pain in a referral center between 2001 and 2013 were retrospectively studied. Patients were included if history and physical examination were suggestive of CECS and if they had undergone a dynamic intracompartmental pressure measurement. Six hundred ninety-eight of 1411 individuals were diagnosed with CECS in one or more of three lower leg muscle compartments (anterior tibial, deep flexor, lateral). Prevalence of CECS peaked around the age of 20–25 years and decreased thereafter, although a plateau around 50 years was found. Age, gender, bilateral symptoms, previous lower leg pathology, sports (running and skating) and tender muscle compartments were identified as independent predictors of lower leg CECS. The proposed predictive model has moderate discriminative ability (AUC 0.66) and good calibration over the complete range of predicted probabilities. The predictive model, displayed as a nomogram, may aid in selecting individuals requiring an invasive dynamic intracompartmental muscle pressure measurement.

scholarly journals Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique

Hand ◽  
2016 ◽  
Vol 12 (5) ◽  
pp. NP58-NP61 ◽  
Author(s):  
Elizabeth A. Miller ◽  
Anna L. Cobb ◽  
Tyson K. Cobb
Keyword(s):  
Case Report ◽  
Compartment Syndrome ◽  
Single Incision ◽  
Invasive Technique ◽  
Compartment Pressure ◽  
Chronic Exertional Compartment Syndrome ◽  
Exertional Compartment Syndrome ◽  
Before And After ◽  
History Of ◽  
Forearm Pain

Background: Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using a minimally invasive technique. Methods: Two professional motocross racers presented with a history of chronic proximal volar forearm pain when motocross riding. Other symptoms included paresthesia and weakness, which, at times, led to an inability to continue riding. Both failed conservative management. Compartment pressure measurements were performed before and after provocative exercises to confirm diagnosis of CECS. Release of both the volar and dorsal compartments was performed endoscopically through a single incision. Results: Symptoms resolved after surgery. The first patient resumed riding at 1 week, competing at 3 weeks, and continues to ride competitively without symptoms at 3 years postoperative. The second patient began riding at 1 week and won second place in the National Supercross finals 5 weeks after simultaneous bilateral release. Conclusions: This technique is simple and effective. The cannula used protects the superficial nerves while allowing release through a small, cosmetically pleasing incision.

scholarly journals Fasciotomy through Multiple Small Skin Incisions for the treatment of early acute osteofascial compartment syndrome in children

2020 ◽  
Author(s):  
Xiaowei Yuan ◽  
Jun Wu ◽  
Xiangyang Qu ◽  
Ming Li ◽  
Linjun Jiang ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Nerve Conduction Velocity ◽  
Pediatric Patients ◽  
Early Stage ◽  
Healing Time ◽  
Compartment Pressure ◽  
Excellent Outcome ◽  
And Function ◽  
Average Procedure Time

Abstract Background The purpose of the present study is to investigate the therapeutic effect of fasciotomy through multiple small skin incisions for the treatment of early osteofascial compartment syndrome in children.Methods From January 2009 to May 2017, 56 pediatric patients with early osteofascial compartment syndrome in their limbs were admitted into our department and treated with multiple small skin incisions for decompression at the early stage. The skin incisions, function and sensation of the limbs were followed up.Results The osteofascial compartment syndrome was diagnosed at 7.4±2.1 hours after injury, and then fasciotomy was performed at 1.4±0.4 hours later. The average procedure time of fasciotomy was 12.7±4.8 minutes. No postoperative incision infections or neurovascular injuries were observed in all the patients. The incisions completely healed in 7-10 days with an average healing time of 8 days without secondary suture. The patients were followed up for an average of 5.1 years. No Volkmann’s contractures in the injured climbs were found. The appearance, electromyography and nerve conduction velocity of the affected limbs were not significantly different from that of the contralateral limbs. All the patients were free of symptoms, were full recovery of sensation and function, being an “excellent” outcome at the latest follow-up. Conclusion Fasciotomy through multiple small skin incisions, which can be useful to decompress the compartment pressure with fewer complications, is a simple and effective strategy for the treatment of early osteofascial compartment syndrome in children.

scholarly journals REAMED TIBIAL INTERLOCK NAILING;

2012 ◽  
Vol 19 (03) ◽  
pp. 312-318
Author(s):  
Muhammad INAM ◽  
Muhammad ARIF ◽  
ABDUL SATTAR
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Lateral Compartment ◽  
Maximum Pressure ◽  
Compartment Pressure ◽  
Posterior Compartment ◽  
Intracompartmental Pressure ◽  
Anterior Compartment ◽  
Vehicle Accident ◽  
Infusion Technique

Objective: The objective is to measure preoperative and postoperative compartment pressure in reamed tibial interlock nailingusing Whitesides infusion technique. Duration: This study is carried out from September 2007 to August 2008 Setting: Department ofOrthopedic and Spine Surgery of Hayatabad Medical Complex Peshawar Material and Methods: Thirty consecutive patients that werecandidates for closed reamed interlock nailing of the tibia and there compartment pressure were measured preoperatively and postoperativelyby Whiteside infusion technique. Results: Average age of patient was 35 years. Male were 26(86.66%) and female were 4(13.34%). Therewere 12(40%) type A and 18(60%) type B fractures according to Orthopedic Trauma Association (OTA) AO classification. Twenty seven (90%)factures were due to motor vehicle accident and 3(10%) were due to fall. The minimum preoperative pressure in superficial posteriorcompartment was 7 millimeter of mercury (mm Hg), deep posterior compartment was 10 mm Hg, anterior compartment was 10 mm Hg, lateralcompartment was 10 mm Hg while maximum pressure in was 25, 25, 25 and 25 mm Hg respectively. The maximum post operative pressure insuperficial posterior compartment was 10 mm Hg minimum and 25 mm Hg maximum, deep posterior compartment was 15 and 28 , anteriorcompartment was 15 and 30 and in lateral compartment was 10 mm Hg minimum and 30 mm Hg maximum. The minimum diastolic bloodpressure was 65 and maximum was 90 mm Hg. Conclusions: Compartment pressure measurement by Whitesides’ infusion technique is asimple and effective method for monitoring the intracompartmental pressure. It avoids unnecessary fasciotomy that has an extra morbidity interms of infection and skin coverage.

scholarly journals The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

2014 ◽  
Vol 8 (1) ◽  
pp. 185-193 ◽  
Author(s):  
James Donaldson ◽  
Behrooz Haddad ◽  
Wasim S Khan
Keyword(s):  
Compartment Syndrome ◽  
Tissue Perfusion ◽  
Surgical Decompression ◽  
Acute Compartment Syndrome ◽  
Definitive Treatment ◽  
Interstitial Pressure ◽  
Compartment Pressure ◽  
Current Management ◽  
Ischaemic Damage

Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

scholarly journals Hand Compartment Syndrome

2021 ◽  
Author(s):  
Ioannis M. Stavrakakis ◽  
George E. Magarakis ◽  
Theodoros H. Tosounidis
Keyword(s):  
Compartment Syndrome ◽  
Pressure Measurement ◽  
High Pressures ◽  
Signs And Symptoms ◽  
Surgical Decompression ◽  
Clinical Image ◽  
Loss Of Function ◽  
Intracompartmental Pressure ◽  
Permanent Loss ◽  
Hand Disability

Compartment syndrome is defined by high pressures in a closed myofascial compartment, which affects initially the muscles and later the nerves and vessels. The hand is rarely affected, but if treated suboptimally, it results to a permanent loss of function. Eleven compartments are included in the hand and wrist. Diagnosis of compartment syndrome of the hand remains challenging. Pain out of proportion of injury and excessive swelling should raise suspicion towards a compartment syndrome. Intracompartmental pressure measurement contributes to the diagnosis, but it is not always reliable. Once the diagnosis of acute compartment syndrome has been made, decompression of all compartments is mandatory, in order to achieve a good outcome. Failing to manage this emergent condition properly leads to a significant hand disability. Our chapter includes the following sections: 1. Introduction. A brief description of the hand compartment syndrome is presented. 2. Anatomy. Special considerations regarding hand compartments are presented, 3. Etiology. 4. Diagnosis. Signs and symptoms are reported, as well as guidelines of the technique of intracompartmental pressure measurement. 5. Treatment. Faciotomies’ indications and operative technique are described in details. 6. Conclusion. Appropriate figures of the clinical image and surgical decompression are presented as well.

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