Intracompartmental Pressure Measurement Research Articles

Towards reducing the trauma of direct intracompartmental pressure measurement for children: an in vitro assessment of small-diameter needles

Direct intracompartmental pressure (ICP) measurement in children is an important investigation, the use of which may be inhibited by the invasive nature of the procedure and the large 18-gauge (G) needles that have hitherto been recommended. These large needles contribute to patient, parental, and physician anxiety. This study compares ICP measurements using needles of different lengths and port configuration, ranging from 18 to 25 G, against the "gold standard" 18 G, long, double-ported needle. All except the 18 G long, single-ported needle had limits of agreement within 3 mm Hg of the gold-standard needle. The results indicate that needle manometry can confidently be performed using small needles, and that the addition of a side-port is unnecessary in needles of small volume.

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Compartment Syndrome Associated with Tibial Fracture*†

TORNETTA, PAUL III M.D.‡, BROOKLYN, NEW YORK; TEMPLEMAN, DAVID M.D.§, MINNEAPOLIS, MINNESOTA Author Information

Exertional Compartment Syndrome of the Leg.

In brief The pain and swelling associated with exertional compartment syndrome is caused by raised intracompartmental pressures possibly induced by muscle swelling or increased osmotic pressure. Although either the acute or chronic form of exertional compartment syndrome may occur, chronic is more common. Patients typically experience pain and swelling and may also have sensory deficits or paresthesias, and motor loss or weakness. Diagnosis is confirmed by intracompartmental pressure measurements before and after exercise. Although activity modification may alleviate symptoms, fasciotomy may be required.

Exertional Compartment Syndrome of the Leg

The pain and swelling associated with exertional compartment syndrome is caused by raised intracompartmental pressures possibly induced by muscle swelling or increased osmotic pressure. Although either the acute or chronic form of exertional compartment syndrome may occur, chronic is more common. Patients typically experience pain and swelling and may also have sensory deficits or paresthesias, and motor loss or weakness. Diagnosis is confirmed by intracompartmental pressure measurements before and after exercise. Although activity modification may alleviate symptoms, fasciotomy may be required.

Is our commonly performed intracompartmental pressure measurement correct?

1. There exits a marked spatial inhomogenity of the intracompartmental pressure following liquid-instillation. 2. The measurement of the compartment pressure should be routinely performed close to the site of the injury, e.g. tibial fracture. Otherwise the measurement causes a serious underestimation of the actual higher compartment pressure resulting in delayed decompressive fasciotomy.

The evaluation and treatment ofexertional compartment syndrome

Exertional compartment syndrome (ECS) is becoming increasingly recognized as a cause of exercise-induced legpain in the athletic population. Unfortunately, the pathophysiology is not clearly understood. The use of 31P-NMR has shown that ischemia is not a significant component of ECS because it is in the acute syndrome. A primary diagnosis can be made after a thorough history and physical examination. In a young patient with leg pain that is only exercise induced, reproducible and associated with a normal physical examination, a diagnosis of ECS is likely and does not need to be a diagnosis of exclusion. Confirmation with intracompartmental pressure measurement still remains the gold standard before further management. Nonoperative management is usually ineffective and fasciotomies of the affected leg(s) and compartment is the recommended treatment in the symptomatic patient. At our center, the use of a two-incision anterior and lateral compartment release, and a one-incision posterior compartment release has been very successful in returning athletes symptom free to their sporting level.

Technique of diagnosis and treatment of the lower extremity compartment syndromes in children

Intracompartmental pressure measurement aids early diagnosis and treatment of acute compartment syndromes.The double incision fasciotomy is the preferred decompression technique.

Intracompartmental Pressure Measurements in the Normal Forearm

Seiler, John Gray III; Womack, Shay; De L'Aune, William R.; Whitesides, Thomas E.; Hutton, William C. Author Information

Evaluation of Limb Compartments With Suspected Increased Interstitial Pressure A Noninvasive Method for Determining Quantitative Hardness

Six compartments in four dogs and three compartments in three anatomic specimen limbs were injected with plasma, and the intracompartmental interstitial pressure and hardness of the compartments were measured. Six patients suspected of having compartment syndromes were also studied. Of the compartments evaluated in the dog and anatomic specimen limbs, the average correlation coefficient between measurements with the two methods was 0.95 (range, 0.87 to 0.99). In six patients suspected of having compartment syndromes, the ratios of quantitative hardness of the injured to uninjured limbs closely matched the intracompartmental interstitial pressure measurement ratios (correlation coefficient, 0.95). All correlation coefficients were significant (F test, p < 0.05). There was a close correlation between the direct measurement of intracompartmental interstitial pressure with the wick catheter and quantitative hardness in compartment syndrome models in dog and anatomic specimen limbs, and in patients suspected of having compartment syndromes. The determination of surface hardness of limb compartments, which appears accurate and reproducible, offers the advantages of being noninvasive and well suited for longer-term assessments of intracompartmental interstitial pressure.

Intracompartmental pressure measurements in the normal forearm.

In 20 normal subjects, intracompartmental pressure measurements were made at three different sites in the volar forearm: half the distance between the medial epicondyle and ulnar styloid and at points 4 cm proximal and 4 cm distal. The pressure measurements were made using a hand-held digital compartment pressure monitor. The study demonstrated that in the uninjured volar compartment, clinically significant (5 mm Hg) intracompartmental pressure differences exist over distances as little as 4 cm.

Measurement of intracompartmental pressure

An experimental model of acute compartment syndrome involving the anterolateral compartment of the hindlimb in dogs was used to compare three methods of measurement of intracompartmental pressure: the simple-needle technique, use of the slit catheter, and use of the side-ported needle. No statistical difference was found between the values obtained with the slit catheter and those obtained with the side-ported needle; the mean difference was 1.4 millimeters of mercury throughout the range of compartment pressures that were measured. The side-ported needle appeared to be as accurate as the slit catheter for the measurement of compartment pressures (p = 0.355, 1-beta = 0.9). The values obtained with use of the simple needle were consistently higher than those obtained with the other two methods (p < 0.001): an average of 18.3 millimeters of mercury higher than the values measured with the slit catheter and 19.3 millimeters of mercury higher than those measured with the side-ported needle. Clinically, the side-ported needle or the slit catheter can be used to obtain accurate measurements of compartment pressure. Use of the simple 18-gauge needle is not recommended for this purpose.

Late presentation of a ruptured iliac aneurysm to a trauma department

Superficial posterior compartment syndromes are very rare. Clinically, diagnosis can be difficult because the signs and symptoms are less obvious than those of the anterior or deep posterior compartments. This case illustrates the importance of an awareness of this condition; we know of several similar cases where a torn muscle has been misdiagnosed as a deep vein thrombosis and the patient has been anticoagulated. This has caused further bleeding from the muscle giving rise to increased compartment pressure. This report serves as a good illustration that the compartments act as individual units and that pressure is not transmitted between them. Barnes M. R., Gibson M. J., Scott I. et al. (1985) A technique for the long-term measurement of intra-compartmental pressure in the lower leg. J. Biomed. Eng. 7, 35. Blandy J. P. and Fuller R. (I957) March gangrene. Ischaemic myositis of the leg muscles from exercise. J. Bone Joint Surg. 39B, 679. Kirby N. G. (/970) Exercise ischaemia in the fascial compartment of soleus. Report of a case. ]. Bone]oint Surg. 52B, 738. Mubarak S. J., Owen C. A., Garfin S. et al. (1978) Acute exertional superfidal posterior compartment syndrome. Am. ]. Sports Med. 6, 287.

Diagnosis and treatment of upper extremity compartment syndrome

The diagnosis of a compartment syndrome in the upper extremity is made on clinical grounds and confirmed by intracompartmental pressure monitoring. The basic techniques for intracompartmental forearm pressure measurements are the wick and slit catheter techniques. The preferred fasciotomy incision for decomposition of the volar compartment and mobile wad is the curvilinear volar incision.

A technique for the long term measurement of intra-compartmental pressure in the lower leg

The early diagnosis of an acute compartmental pressure syndrome is often difficult, but can be facilitated by long term, up to several days, measurement of intra-compartmental pressures. A measuring system has been developed, together with its associated surgical and operational procedures, which may be applied in a variety of situations, including an immobile patient or a patient mobilized following surgery. If the technique is adopted as soon as the patient enters hospital, or immediately postoperatively, an acute compartmental syndrome may be recognized early and measures taken to alleviate its consequences.

The effect of antivenin on intramuscular pressure elevations induced by rattlesnake venom

The dose of an antivenin required to neutralize a clinical case of venom poisoning, as well as determining the timing or need to initiate antivenin treatment, is frequently difficult to objectively ascertain. In this study, venom from the southern Pacific rattlesnake, Crotalus viridis helleri, was injected into 29 dog hind limb anterolateral compartments. A solution of C. v. helleri venom (15 mg/ml) was prepared using dessicated venom and saline; 0.2 ml were injected sub-fascially so that each of the compartments received 3 mg of venom. In one group no antivenin was given, in a second group four vials of antivenin were administered i.v. 1 hr post-injection, and in the final group eight vials of antivenin were administered i.v. 1 hr following venom injection. In all groups intracompartment pressures, limb girth and surface temperature were measured at regular intervals over the first 48 hr. In the group receiving eight vials of antivenin the intracompartment pressure reached a peak mean pressure of 49 mm Hg at 2 – 4 hr, and then rapidly fell. In those treated with none or four vials the pressure rose to 70 and 60 mm Hg, respectively, and remained elevated over the first 24 hr. The difference between the former and latter two groups is statistically significant. The findings indicate that the intracompartmental pressure, and presumably destructive damage of the venom, can be controlled by adequate levels of i.v. antivenin. Intracompartmental pressure measurements should be considered as an adjunct in the monitoring and decision-making processes for the treatment of patients bitten by rattlesnakes.

Measurement of intracompartmental pressure in the back

Measurement of intracompartmental pressure in the back

A Study on Measurement of Intracompartmental Pressure About Measuring Method and Normal Value

A Study on Measurement of Intracompartmental Pressure About Measuring Method and Normal Value

Quantitation of skeletal-muscle necrosis in a model compartment syndrome.

Skeletal-muscle necrosis was evaluated in previously pressurized canine compartments using technetium-99m stannous pyrophosphate and classic histological criteria. Intracompartmental necrosis was quantitated in the anterolateral muscle compartment of each dog by uptake of 99mTc stannous pyrophosphate using the contralateral anterolateral compartment as an internal control. Representative specimens of muscle were sampled in experimental and control legs of each dog and were analyzed by qualitative histological techniques. Muscle necrosis was assessed in compartments forty-eight hours after pressurization to levels of ten to 120 millimeters of mercury for eight hours in thirty-seven dogs. In another dog, neither anterolateral compartment was pressurized so that both compartments acted as control muscle. The results in these experiments identify a threshold pressure level (thirty millimeters of mercury) and duration (eight hours) at which significant muscle necrosis occurs at normal blood pressure. Our findings imply that a quantitative relationship exists between incorporation of 99mTc stannous pyrophosphate and the level of intracompartmental pressure. This uptake technique, however, is not suitable for diagnosing compartment syndrome in patients with a threatened compartment syndrome. We suggest that intracompartmental pressure measurements by the wick-catheter technique, in conjunction with clinical findings, offer the best means for diagnosing compartment syndrome. Significant muscle necrosis associated with an impending compartment syndrome occurs at a threshold intracompartmental pressure of thirty millimeters of mercury after eight hours. Since time variables are often unknown in suspected compartment syndromes, fasciotomy is recommended when intracompartmental pressure exceeds thirty millimeters of mercury in a patient with normal blood pressure. The use of this threshold pressure level as an indication for fasciotomy requires a device for measuring intracompartmental pressure such as the wick catheter.

The Painful Chronic Anterior Lower Leg Syndrome:A Prospective Clinical and Experimental Study

A presumed painful chronic anterior lower leg syndrome was diagnosed in 51 patients (73 legs), 30 women and 21 men, aged 11 to 70 years, over a 2-year period. The duration of the syndrome varied from 1 month to 10 years. The patients' main complaint was pain when walking located in the medial ventral muscle compartment of the lower leg. In addition 10 of the patients (15 legs) had leg pain at rest as well and 12 (15 legs) had paresis of the extensor muscles. Thirty-four paired intracompartmental pressure recordings with the wick technique in 6 patients suggest that the more severe the syndrome the lower the pressure in the tibialis anterior muscle. Blind diathermic fasciotomy in 25 patients (36 legs) with a typical history relieved the pain and paresis completely or partly in 33 (92 per cent) out of 36 legs. No postoperative complications worth mentioning were observed. It is concluded that: 1) a chronic painful anterior lower leg syndrome should be suspected in patients with pain on walking and at rest located in the ventral part of the lower leg; 2) intracompartmental pressure measurements seem to be of little preoperative diagnostic value in non-selected patients; 3) blind diathermic fasciotomy of the anterior, medial compartment of the lower leg, including the extensor retinaculum, gives relief from pain and paresis in most patients with a typical history.

Basic Principles of Fracture Therapy

Acute compartment syndrome (ACS) of the lower leg is a time-sensitive orthopedic emergency that relies heavily on precise clinical findings. Late findings of ACS can lead to limb amputation, contractures, paralysis, multiorgan failure, and death. Hallmark symptoms of ACS include the 6 P's: pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis. Suspicion of ACS is confirmed by measurement of intracompartmental pressure of the affected compartment. The definitive treatment of ACS is timely fasciotomy. We review the pathophysiology, common causes, diagnosis, and treatment of this potentially devastating condition.