Initial intramuscular perfusion pressure predicts early skeletal muscle function following isolated tibial fractures

Michael Müller,Klaus D Schaser,Aleaxander C Disch,Nicole Zabel,Norbert P Haas

doi:10.1186/1749-799x-3-14

Michael Müller, Klaus D Schaser + Show 3 more

Open Access

https://doi.org/10.1186/1749-799x-3-14

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Abstract

BackgroundThe severity of associated soft tissue trauma in complex injuries of the extremities guides fracture treatment and decisively determines patient's prognosis. Trauma-induced microvascular dysfunction and increased tissue pressure is known to trigger secondary soft tissue damage and seems to adversely affect skeletal muscle function.Methods20 patients with isolated tibial fractures were included. Blood pressure and compartment pressure (anterior and deep posterior compartment) were measured continuously up to 24 hours. Corresponding perfusion pressure was calculated. After 4 and 12 weeks isokinetic muscle peak torque and mean power of the ankle joint in dorsal and plantar flexion were measured using a Biodex dynamometer.ResultsA significant inverse correlation between the anterior perfusion pressure at 24 hours and deficit in dorsiflexion at 4 weeks was found for both, the peak torque (R = -0.83; p < 0.01) and the mean power (R = -0.84; p < 0.01). The posterior perfusion pressure at 24 h and the plantar flexion after 4 weeks in both, peak torque (R = -0.73, p =< 0.05) and mean power (R = -0.7, p =< 0.05) displayed a significant correlation.ConclusionThe functional relationship between the decrease in intramuscular perfusion pressures and muscle performance in the early rehabilitation period indicate a causative and prognostic role of early posttraumatic microcirculatory derangements and skeletal muscle function. Therapeutic concepts aimed at effective muscle recovery, early rehabilitation, and decreased secondary tissue damage, should consider the maintenance of an adequate intramuscular perfusion pressure.

Highlights

The severity of soft tissue trauma and the degree of secondary tissue damage, has a fundamental impact on the mid- and longterm prognosis of complex injuries to the extremities [1,2,3]
In normotonic individuals, compartment pressure monitoring is recommended in order to anticipate the transition from impending, to the manifestation of compartment syndrome [8,10,11,12]
The decrease in perfusion pressure after 24 hours, which was associated with a deficit in dorsiflexion and plantar flexion of the ankle joint after 4 weeks, indicates a causal-prognostic role of early microcirculatory deteriorations for a manifestation/development of skeletal muscle dysfunction, after four weeks post trauma

Summary

Introduction

The severity of soft tissue trauma and the degree of secondary tissue damage, has a fundamental impact on the mid- and longterm prognosis of complex injuries to the extremities [1,2,3]. An increased compartment pressure beyond a critical threshold (acute compartment syndrome) deteriorates the nutritive perfusion by external capillary compression and restricts oxygen delivery. This causes tremendous pain and converges into a fatal vicious circle, of ischemia, inflammation and irreversible damage to vital neuromuscular structures [6,8,9]. Based on these underlying pathomechanisms, the established treatment for acute compartment syndrome includes an emergency fasciotomy, allowing the intramuscular pressure to decline. Trauma-induced microvascular dysfunction and increased tissue pressure is known to trigger secondary soft tissue damage and seems to adversely affect skeletal muscle function

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