Near-infrared spectroscopy in acute compartment syndrome: Case report

Abstract

A 44-year-old Caucasian male was treated with external fixation to stabilise a proximal tibia fracture with an articular split. Postoperatively, the patient became hypersensitive to pain in both the injured and uninjured legs. Intramuscular pressures (IMPs) were measured in all four compartments of the injured extremity resulting in 40-mmHg perfusion pressure in all four compartments. (Perfusion pressure was defined as diastolic blood pressure minus IMP.) Tissue oxygenation was measured using two near-infrared spectroscopy (NIRS) pads (INVOS, Somanetics, Troy, MI, USA). NIRS pads were placed on the lateral and deep posterior compartments for continual monitoring as described by Shuler et al. (All clinical decisions were based on the clinical symptoms and pressure measurements and not on the NIRS information.) Repeat IMPs were obtained 2 h later and confirmed adequate perfusion gradients of at least 40 mmHg in all four compartments. Approximately 24 h after the initial injury and 18 h after external fixation, the patient began requiring more pain medication. IMP measurements were repeated a third time. The perfusion gradients for the posterior compartments were 11 mmHg, whilst the anterior and lateral were maintained over 20 mmHg of perfusion gradient. A four-compartment fasciotomy was performed. During the release, no gross evidence of muscle necrosis was found.