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Erschienen in: European Journal of Trauma and Emergency Surgery 6/2015

01.12.2015 | Review Article

Assessment of elevated compartment pressures by pressure-related ultrasound: a cadaveric model

verfasst von: R. M. Sellei, S. J. Hingmann, C. Weber, S. Jeromin, F. Zimmermann, J. Turner, F. Hildebrand, H.-C. Pape

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 6/2015

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Abstract

Purpose

There is a risk of misinterpreting the clinical signs of acute compartment syndrome of the lower limb resulting in delayed fasciotomy. Up to date, the diagnosis of compartment syndrome is based on clinical assessment and of invasive needle pressure measurement in uncertain cases. Close monitoring is necessary for early recognition of raising compartment pressures. Clinical assessment of muscle firmness by the physician’s palpation alone is unreliable. Thus, a device objectifying this assessment would be beneficial. The purpose of this study was to determine the feasibility of muscle compartment elasticity measurements by a novel and non-invasive device using pressure-related ultrasound.

Methods

In a cadaveric model, the anterior tibial compartment was prepared to simulate raising intra-compartmental pressures (0–80 mmHg) by saline infusion. Standard invasive pressure monitoring was compared with a novel method to determine tissue elasticity. Changing cross-sectional view in B-mode ultrasound was exerted to measure the compartment depth before and after physician’s probe compression of 100 mmHg. Compartment displacement (∆d) was measured and related to the corresponding compartmental pressure (Spearman correlation coefficient). Delta (mm) of the control group at 10 mmHg compartment pressure was compared with measured data at rising compartmental pressures of 30, 50, and 70 mmHg using the Wilcoxon rank-sum test. The intra-observer reliability (κ) was additionally calculated.

Results

Fresh and never frozen lower human limbs (n = 6) were used. The average displacement measured in the anterior tibial compartment was 2.7 mm (0.3–6.7 mm). A concordant consistent correlation between the compartmental displacement and the intra-compartmental pressure occurred. The Spearman coefficient (r s = 0.979) showed a significant correlation between the rising pressure and the decreasing tissue displacement visualized by ultrasound. The intra-observer value kappa showed reliable values (κ 10 = 0.73, κ 30 = 0.80, and κ 70 = 0.79).

Conclusions

We introduce a new method of ultrasound imaging enhanced with probe pressure measurement to determine changes of the visco-elastic behavior of isolated muscle compartments. Pressure-related ultrasound could be a reliable tool to determine the correlation between the measured compartmental displacement and the increasing intra-compartmental pressure. Its accuracy revealed promising results. This technique may help the physician to objectify the clinical assessment of compartment elasticity, mainly indicated in cases of unconscious patients and imminent pathology. Further clinical studies and improvements of this technique are required to prove its accuracy and reliability in cases of compartment syndrome.
Literatur
1.
Zurück zum Zitat Mubarak SJ, Hargens AR. Acute compartment syndromes. Surg Clin North Am. 1983;63:539–65.PubMed Mubarak SJ, Hargens AR. Acute compartment syndromes. Surg Clin North Am. 1983;63:539–65.PubMed
2.
Zurück zum Zitat Heckman MM, Whiteside TE Jr, Grewe SR, et al. Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma. 1993;7:199–210.CrossRefPubMed Heckman MM, Whiteside TE Jr, Grewe SR, et al. Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma. 1993;7:199–210.CrossRefPubMed
3.
Zurück zum Zitat Finkelstein J, Hunter G, Hu R, et al. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma. 1996;40:342–4.CrossRefPubMed Finkelstein J, Hunter G, Hu R, et al. Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma. 1996;40:342–4.CrossRefPubMed
4.
Zurück zum Zitat McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996;78:95–8.PubMed McQueen MM, Christie J, Court-Brown CM. Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br. 1996;78:95–8.PubMed
5.
Zurück zum Zitat Rorabeck CH. The treatment of compartment syndrome of the leg. J Bone Joint Surg Br. 1984;66:93–7.PubMed Rorabeck CH. The treatment of compartment syndrome of the leg. J Bone Joint Surg Br. 1984;66:93–7.PubMed
6.
Zurück zum Zitat Oprel PP, Eversdijk MG, Vlot J, et al. The acute compartment syndrome of the lower leg: a difficult diagnosis? Open Orthop J. 2010;4:115–9.PubMedCentralPubMed Oprel PP, Eversdijk MG, Vlot J, et al. The acute compartment syndrome of the lower leg: a difficult diagnosis? Open Orthop J. 2010;4:115–9.PubMedCentralPubMed
7.
Zurück zum Zitat Giannoudis PV, Nicolopoulos C, Dinopoulos H, et al. The impact of lower leg compartment syndrome on health related quality of life. Injury. 2002;33(2):117–21.CrossRefPubMed Giannoudis PV, Nicolopoulos C, Dinopoulos H, et al. The impact of lower leg compartment syndrome on health related quality of life. Injury. 2002;33(2):117–21.CrossRefPubMed
8.
Zurück zum Zitat Shuler FD, Dietz MJ. Physicians’ ability to manually detect isolated elevations in leg intracompartmental Pressure. J Bone Joint Surg Am. 2010;92:361–7.CrossRefPubMed Shuler FD, Dietz MJ. Physicians’ ability to manually detect isolated elevations in leg intracompartmental Pressure. J Bone Joint Surg Am. 2010;92:361–7.CrossRefPubMed
9.
Zurück zum Zitat Prayson MJ, Chen JL, Hampers D, et al. Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome. J Trauma. 2006;60:1037–40.CrossRefPubMed Prayson MJ, Chen JL, Hampers D, et al. Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome. J Trauma. 2006;60:1037–40.CrossRefPubMed
10.
Zurück zum Zitat Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16:572–7.CrossRefPubMed Ulmer T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16:572–7.CrossRefPubMed
11.
Zurück zum Zitat Shadgan B, Menon M., O’Brien PJ, et al. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma. 2008; 22:581–587. Shadgan B, Menon M., O’Brien PJ, et al. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma. 2008; 22:581–587.
12.
Zurück zum Zitat Al-Dadah OQ, Darrah C, Cooper A, et al. Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures. Injury. 2008;39:1204–9.CrossRefPubMed Al-Dadah OQ, Darrah C, Cooper A, et al. Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures. Injury. 2008;39:1204–9.CrossRefPubMed
13.
Zurück zum Zitat Shadgan B, Menon M, Sanders D, et al. Current thinking about acute compartment syndrome of the lower extremity. Can J Surg. 2010;53:329–34.PubMedCentralPubMed Shadgan B, Menon M, Sanders D, et al. Current thinking about acute compartment syndrome of the lower extremity. Can J Surg. 2010;53:329–34.PubMedCentralPubMed
14.
Zurück zum Zitat Ramana YV, Krishna GG, Khadeer MA. Shear velocity of muscle tissue. J Biomed Eng. 1980;2:211–5.CrossRefPubMed Ramana YV, Krishna GG, Khadeer MA. Shear velocity of muscle tissue. J Biomed Eng. 1980;2:211–5.CrossRefPubMed
15.
Zurück zum Zitat Aaron R, Huang M, Shiffman CA. Anisotropy of human muscle via non-invasive impedance measurements. Phys Med Biol. 1997;42:1245–62.CrossRefPubMed Aaron R, Huang M, Shiffman CA. Anisotropy of human muscle via non-invasive impedance measurements. Phys Med Biol. 1997;42:1245–62.CrossRefPubMed
16.
Zurück zum Zitat Murayama G, Nosaka K, Yoneda T, et al. Changes in stiffness of the human elbow flexor muscles after eccentric exercise. Eur J Appl Physiol. 2000;82:361–7.CrossRefPubMed Murayama G, Nosaka K, Yoneda T, et al. Changes in stiffness of the human elbow flexor muscles after eccentric exercise. Eur J Appl Physiol. 2000;82:361–7.CrossRefPubMed
17.
Zurück zum Zitat Arokoski JPA, Srakka J, Ojala T, et al. Feasibility of the use of a novel soft tissue stiffness meter. Physiol Meas. 2005;26:215–28.CrossRefPubMed Arokoski JPA, Srakka J, Ojala T, et al. Feasibility of the use of a novel soft tissue stiffness meter. Physiol Meas. 2005;26:215–28.CrossRefPubMed
18.
Zurück zum Zitat Steinberg BD, Gelberman RH. Evaluation of limb compartments with suspected increased interstitial pressure. A non-invasive method for determining quantitative stiffness. Clin Orthop Relat Res. 1994;300:248–53.PubMed Steinberg BD, Gelberman RH. Evaluation of limb compartments with suspected increased interstitial pressure. A non-invasive method for determining quantitative stiffness. Clin Orthop Relat Res. 1994;300:248–53.PubMed
19.
Zurück zum Zitat Steinberg BD. Evaluation of limb compartments with increased interstitial pressure. An improved noninvasive method for determining quantitative hardness. J Biomech. 2005;38:1629–35.CrossRefPubMed Steinberg BD. Evaluation of limb compartments with increased interstitial pressure. An improved noninvasive method for determining quantitative hardness. J Biomech. 2005;38:1629–35.CrossRefPubMed
20.
Zurück zum Zitat Ophir J, C’espedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissue. Ultrason Imaging. 1991;13:111–34.CrossRefPubMed Ophir J, C’espedes I, Ponnekanti H, et al. Elastography: a quantitative method for imaging the elasticity of biological tissue. Ultrason Imaging. 1991;13:111–34.CrossRefPubMed
21.
Zurück zum Zitat C’espedes I, Ophir J, Ponnekanti H, et al. Elastography: elasticity imaging using ultrasound with application to muscle and breast in vivo. Ultrason Imaging. 1993;15:73–88.CrossRef C’espedes I, Ophir J, Ponnekanti H, et al. Elastography: elasticity imaging using ultrasound with application to muscle and breast in vivo. Ultrason Imaging. 1993;15:73–88.CrossRef
22.
Zurück zum Zitat Gennisson JL, Cornu C, Cathline S, et al. Human muscle hardness assessment during incremental isometric contraction using transient elastography. J Biomech. 2005;38:1543–50.CrossRefPubMed Gennisson JL, Cornu C, Cathline S, et al. Human muscle hardness assessment during incremental isometric contraction using transient elastography. J Biomech. 2005;38:1543–50.CrossRefPubMed
23.
Zurück zum Zitat Kimura K, Watanabe Y, Umeda M, et al. Quantitative analysis of the relation between soft tissue stiffness palpated from the body surface and tissue hemodynamic in the human forearm. Physiol Meas. 2007;28:1495–505.CrossRefPubMed Kimura K, Watanabe Y, Umeda M, et al. Quantitative analysis of the relation between soft tissue stiffness palpated from the body surface and tissue hemodynamic in the human forearm. Physiol Meas. 2007;28:1495–505.CrossRefPubMed
24.
Zurück zum Zitat Gershuni DH, Gosink BB, Hargens AR, et al. Ultrasound evaluation of the anterior musculofascial compartment of the leg following exercise. Clin Orthop Rel Res. 1982;167:185–90. Gershuni DH, Gosink BB, Hargens AR, et al. Ultrasound evaluation of the anterior musculofascial compartment of the leg following exercise. Clin Orthop Rel Res. 1982;167:185–90.
Metadaten
Titel
Assessment of elevated compartment pressures by pressure-related ultrasound: a cadaveric model
verfasst von
R. M. Sellei
S. J. Hingmann
C. Weber
S. Jeromin
F. Zimmermann
J. Turner
F. Hildebrand
H.-C. Pape
Publikationsdatum
01.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 6/2015
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-014-0449-9

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