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المصدر: The Journal of the American Academy of Orthopaedic Surgeons. 30(6)
مصطلحات موضوعية: Humans, Orthopedics and Sports Medicine, Surgery, Compartment Syndromes
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0cdd516d185c2b1268b61f92e4eff40c
https://pubmed.ncbi.nlm.nih.gov/35192561 -
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المؤلفون: Kathy L. Ryan, Alan R. Hargens, Thomas J. Walters, Melissa A Kottke
المصدر: Journal of Trauma and Acute Care Surgery. 87:S59-S66
مصطلحات موضوعية: medicine.medical_specialty, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Compartment Syndromes, Fasciotomy, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Compartment (pharmacokinetics), Iraq War, 2003-2011, Diagnostic Techniques and Procedures, Afghan Campaign 2001, business.industry, Gold standard, Extremities, 030208 emergency & critical care medicine, Evidence-based medicine, Clinical trial, Traumatic injury, Amputation, Acute Disease, War-Related Injuries, Surgery, Radiology, business, Perfusion
الوصف: Acute compartment syndrome (ACS) is a serious medical condition that can occur following traumatic injury to an extremity. If left undiagnosed, ACS can eventuate in amputation of the limb or even death. Because of this, fasciotomy to release the pressure within the muscle and restore tissue perfusion is often performed upon suspicion of ACS, as the sequelae to fasciotomy are less severe than those associated with not performing the fasciotomy. Currently, the "gold standard" of diagnosis is based on clinical assessment of such symptoms as pain out of proportion to the injury, obvious high pressure and swelling, pain on passive stretch of the muscles in the affected compartment, and deficits in sensory and/ormotor functions. Diagnosis is often confirmed using invasive measurements of intramuscular pressure (IMP); however, controversy exists as to how direct IMP measurement should be accomplished and threshold pressures for accurate diagnosis. Because of this and the attendant issues with invasive measurements, investigators have been searching over the last 25 years for a noninvasive means to quantitatively measure IMP or perfusion to the limb. The purpose of this review is to summarize the current state of the art of noninvasive devices that could potentially be used to diagnose ACS accurately and objectively. To do this, we divide the discussion into those medical devices that primarily measure mechanical surrogates of IMP (e.g., tissue hardness or myofascial displacement) and those that primarily measure indices of tissue perfusion (e.g., tissue oxygen saturation via near-infraredspectroscopy). While near-infrared spectroscopy-basedtechnologies have shown the most promise, whether such technologies will be of diagnostic benefit await the completion of ongoing clinical trials. LEVEL OF EVIDENCE: Systematic Review, level II.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::867c346aceb73d2fa4b2f0d4f8d8e4be
https://doi.org/10.1097/ta.0000000000002284 -
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المصدر: Journal of Orthopaedic Trauma. 23:186-192
مصطلحات موضوعية: Manometry, Swine, medicine.medical_treatment, Compartment Syndromes, Sensitivity and Specificity, Article, Image Interpretation, Computer-Assisted, medicine, Animals, Humans, Orthopedics and Sports Medicine, Displacement (orthopedic surgery), Compartment (pharmacokinetics), Saline, Ultrasonography, business.industry, Ultrasound, Reproducibility of Results, General Medicine, Anatomy, Perfusion, body regions, Disease Models, Animal, Catheter, Blood pressure, Surgery, business, Nuclear medicine
الوصف: Objectives: Acute compartment syndrome (ACS) is the result of decreased perfusion pressure (PP), and the diagnosis frequently requires invasive monitoring. Our objective was to test a new noninvasive ultrasound device for correlating PP with measurements of fascial displacement in a controlled porcine model of ACS. We hypothesized that fascial displacement in experimental compartments with impaired PP would be significantly greater than that in control compartments with normal baseline PP. Methods: ACS was generated in right anterior compartments of 7 anesthetized pigs, and contralateral compartments served as normal controls. Intramuscular pressure in all compartments was monitored by slit catheters, whereas intramuscular pressure in experimental compartments was elevated in 10 mm Hg increments by infusing 0.045% albumin in saline. A noninvasive ultrasound device continuously recorded fascial displacement corresponding to arterial pressure pulses in all compartments. Mean fascial displacement amplitude was grouped by PP and analyzed using 2-way repeated measures analysis of variance and contrast analysis. Results: As PP ranged from 80 to -40 mm Hg, the change in fascial displacement of the infused compartments was significantly greater than that in the control compartments (analysis of variance, P = 0.03). At each PP increment between 40 and -20 mm Hg, fascial displacement in the infused compartments was significantly greater than that in the control compartments (contrast analysis, P < 0.014). Conclusions: Fascial displacement is significantly greater in muscle compartments with decreased PP. Furthermore, changes in PP are associated with changes in fascial displacement over a clinically relevant range of PP, making this noninvasive technique potentially useful for monitoring in ACS.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::204e198d2601be3fbbe0d378f6900772
https://doi.org/10.1097/bot.0b013e31819901db -
4
المصدر: Journal of Orthopaedic Research. 27:489-494
مصطلحات موضوعية: medicine.medical_specialty, Receiver operating characteristic, business.industry, Ultrasound, Compartment Syndromes, Recursive partitioning, Fascia, biochemical phenomena, metabolism, and nutrition, Surgery, enzymes and coenzymes (carbohydrates), Blood pressure, medicine.anatomical_structure, polycyclic compounds, bacteria, Medicine, Orthopedics and Sports Medicine, Ankle, business, Compartment (pharmacokinetics), Nuclear medicine
الوصف: Compartment syndromes, caused by elevated intramuscular pressure (IMP) and resulting from trauma or chronic overuse, frequently require invasive IMP monitoring for accurate diagnosis. Our objective is to test a non-invasive ultrasound technique for estimating IMP based on fascial displacement waveforms from arterial blood pressure pulses. In this study, IMP was increased in the legs of 23 healthy adult subjects up to 80 mmHg using two blood pressure cuffs covering the region from the knee to the ankle. Receiver operator characteristic (ROC) curves and recursive partitioning were used to determine the sensitivity and specificity of diagnosing elevated IMP using fascial displacement. For one ROC curve, in which several ultrasonic measurement parameters were used along with subject body mass index and blood pressure, the sensitivity and specificity for diagnosing normal IMP (below 30 mmHg) from elevated IMP (30 mmHg and up) was 0.61 and 0.94 respectively. Recursive partitioning, in which IMP was divided into three ranges (normal = 50 mmHg), resulted in improved diagnostic sensitivity (0.77) with almost no change in specificity (0.93).
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المؤلفون: Bryan T. Leek, Adnan Cutuk, John M. Wiemann, R. Scott Meyer, Brandon R. Macias, Alan R. Hargens
المصدر: The Journal of Bone & Joint Surgery. 89:1941-1947
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Sling (implant), Kneeling position, Posture, Blood Pressure, Compartment Syndromes, Weight-Bearing, Spine surgery, Risk Factors, mental disorders, Pressure, Prone Position, Transducers, Pressure, medicine, Humans, Orthopedics and Sports Medicine, Muscle, Skeletal, Intramuscular pressure, Monitoring, Physiologic, business.industry, Body Weight, Kneeling, General Medicine, Spine, Surgery, Prone position, medicine.anatomical_structure, Blood pressure, Lower Extremity, Ankle, business, human activities
الوصف: Background: Acute compartment syndrome has been an underreported complication during spine surgery with the patient positioned on the so-called 90/90 kneeling frame (with 90° of both hip and knee flexion), presumably because of elevated intramuscular pressures in the dependent leg compartments. The purpose of the present study was to characterize and quantify certain parameters that affect the risk for acute compartment syndrome experimentally and to make objective comparisons with other spine surgery positions. Methods: Eight healthy volunteers were positioned in three spine surgery positions: the 90/90 kneeling position, the so-called 45/45 suspended position (with the hips and knees both flexed to 45° with the legs suspended on a sling), and the prone position. Intramuscular pressures were measured in all four left leg compartments with slit catheters. Local blood pressure and applied load beneath the leg were also measured. Results: The 90/90 kneeling position was associated with significantly increased intramuscular pressure in the anterior compartment (30.8 ± 5.7 mm Hg) in comparison with the prone position (13.5 ± 1.7 mm Hg) and the 45/45 suspended position (13.8 ± 1.7 mm Hg). In the 90/90 kneeling position, these values correlated with subject weight (r = 0.72, p = 0.045) and the applied body weight load measured beneath the leg (r = 0.74, p = 0.037). The mean differences between intramuscular pressure and ankle blood pressure were more pronounced as the position of the ankle dropped below the level of the heart in the 45/45 suspended and the 90/90 kneeling positions. Conclusions: The 90/90 kneeling position results in elevated intramuscular pressure in the anterior compartment of the leg. This elevated pressure correlates also with subject weight. The 90/90 kneeling position may predispose patients to the development of an acute compartment syndrome during prolonged spine surgery, with heavier patients being at increased risk. In certain instances, the surgeon may consider using the 45/45 suspended position to minimize this risk.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::21c29a213bf6583703d2fce5a8455045
https://doi.org/10.2106/jbjs.f.00943 -
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المؤلفون: Alan R. Hargens, Robert A. Pedowitz, Brian Hunter, Joan E. Bechtold, Rick M. Odland, Bradley M Linzie, Andrew H. Schmidt, Lou Kidder
المصدر: Journal of Orthopaedic Trauma. 19:267-275
مصطلحات موضوعية: medicine.medical_specialty, Mean arterial pressure, Swine, medicine.medical_treatment, Urology, Ultrafiltration, Pilot Projects, Compartment Syndromes, chemistry.chemical_compound, Interstitial fluid, Lactate dehydrogenase, Edema, Pressure, medicine, Animals, Orthopedics and Sports Medicine, Creatine Kinase, Saline, L-Lactate Dehydrogenase, biology, business.industry, General Medicine, Compartment (chemistry), Surgery, Blood pressure, chemistry, biology.protein, Creatine kinase, medicine.symptom, business
الوصف: Objectives To demonstrate the efficacy of compartment syndrome ultrafiltration for the treatment of acute compartment syndrome in an animal model. Our hypothesis is the removal of interstitial fluid will result in a reduction of intramuscular pressure compared with untreated controls in a model of bilateral induced compartment syndrome. Design Controlled experimental model. Setting Animal research facility. Patients/participants Three pairs of porcine hindlimbs. Intervention Acute compartment syndrome was created in the pig hindlimb by infusion of saline to maintain the intramuscular pressure 30 mm Hg greater than the animal's mean arterial pressure for 8 hours. After a 2-hour reperfusion interval, ultrafiltration (removal of fluid through 1 mm diameter porous catheters, connected to -500 mm Hg suction) was commenced in 1 limb only and continued for 9.5 hours. Main outcome measures Intramuscular pressure, ultrafiltrate volume, ultrafiltrate and serum levels of creatine kinase and lactate dehydrogenase, histologic measurement of extracellular and intracellular edema, as well as the degree of cellular necrosis. Results Intramuscular pressure tended to be lower on the treated side at the end of the treatment period [treated leg: 9.3 +/- 4.0 mm Hg (+/- SE), control leg: 19.3 +/- 1.4 mm Hg, P = 0.03]. Analysis of ultrafiltrate fluid showed that levels of creatine kinase and lactate dehydrogenase were elevated compared with serum levels. Creatine kinase levels in serum were measured at 4150 +/- 780 U/L, whereas ultrafiltrate levels of creatine kinase were 28,700 +/- 17,700 U/L (+/- SE) (P = 0.1). Lactate dehydrogenase was measured at 1950 +/- 180 U/L in serum, but markedly elevated in ultrafiltrate [160,000 +/- 88,900 U/L (+/- SE), P = 0.05]. Quantification of cellular and interstitial dimensions showed no difference in control and experimental limbs. Quantification of the degree of muscle necrosis revealed 6.1 +/- 2.7% necrosis in the treated limb compared to 11.3 +/- 1.6% necrosis in the control group (P = 0.02, df = 2, 1-tailed paired t test). Conclusion This pilot study demonstrates the feasibility of tissue ultrafiltration for reduction of intramuscular pressure in this porcine model. Further studies are underway. Compartment syndrome ultrafiltration may be useful prophylactically in patients at risk for acute compartment syndrome. Sampling of interstitial fluid and frequent measurement of intramuscular pressure may allow earlier diagnosis and treatment of acute compartment syndrome, whereas the reduction of tissue pressure by compartment syndrome ultrafiltration may prevent acute compartment syndrome from occurring. Additionally, compartment syndrome ultrafiltration will not hinder the ability of clinicians to use the clinical examination and pressure monitoring as the gold standard.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f2c7aae4471c17f908c27c521fe9c8ed
https://doi.org/10.1097/01.bot.0000155308.20133.71 -
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المؤلفون: Alan R. Hargens, Scott J. Mubarak
المصدر: Hand Clinics. 14:371-383
مصطلحات موضوعية: medicine.medical_specialty, business.industry, Vascular disease, Compartment Syndromes, medicine.disease, Pathophysiology, Extracorporeal, Surgery, Catheter, Blood pressure, Internal medicine, medicine, Cardiology, Orthopedics and Sports Medicine, Differential diagnosis, business, Compartment (pharmacokinetics)
الوصف: This article reviews present knowledge of the pathophysiology and diagnosis of acute compartment syndromes. Recent results using compression of legs in normal volunteers provide objective data concerning local pressure thresholds for neuromuscular dysfunction in the anterior compartment. Results with this model indicate that a progression of neuromuscular deficits occurs when IMP increases to within 35 to 40 mm Hg of diastolic blood pressure. These findings provide useful information on the diagnosis and compression thresholds for acute compartment syndromes. Time factors are also important, however, and usually are incompletely known in most cases of acute compartment syndrome. Although the slit catheter is a very good technique for monitoring IMP during rest, these catheters and their associated extracorporeal transducer systems are not ideal. Recently developed miniature transducer-tipped catheters and, perhaps, future development of noninvasive techniques may provide accurate recordings of IMP in patients with acute compartment syndromes.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::f87ead793268b56f15ffc1eec57a1af2
https://doi.org/10.1016/s0749-0712(21)00396-6 -
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المصدر: The Journal of Bone & Joint Surgery. 79:844-9
مصطلحات موضوعية: medicine.medical_specialty, Time Factors, Muscle Relaxation, Rest, Physical Exertion, Ischemia, Physical exercise, Compartment Syndromes, Hemoglobins, Oxygen Consumption, Millimeter of mercury, Pressure, medicine, Humans, Orthopedics and Sports Medicine, Muscle, Skeletal, Compartment (pharmacokinetics), Chronic exertional compartment syndrome, Leg, Spectroscopy, Near-Infrared, Myoglobin, business.industry, Vascular disease, General Medicine, Oxygenation, Tourniquets, medicine.disease, Surgery, Anterior Compartment Syndrome, Case-Control Studies, Anesthesia, Chronic Disease, business, Muscle Contraction
الوصف: Currently, the definitive diagnosis of chronic compartment syndrome is based on invasive measurements of intracompartmental pressure. We measured the intramuscular pressure and the relative oxygenation in the anterior compartment of the leg in eighteen patients who were suspected of having chronic compartment syndrome as well as in ten control subjects before, during, and after exercise. Chronic compartment syndrome was considered to be present if the intramuscular pressure was at least fifteen millimeters of mercury (2.00 kilopascals) before exercise, at least thirty millimeters of mercury (4.00 kilopascals) one minute after exercise, or at least twenty millimeters of mercury (2.67 kilopascals) five minutes after exercise. Changes in relative oxygenation were measured with use of the non-invasive method of near-infrared spectroscopy. In all patients and subjects, there was rapid relative deoxygenation after the initiation of exercise, the level of oxygenation remained relatively stable during continued exercise, and there was reoxygenation to a level that exceeded the pre-exercise resting level after the cessation of exercise. During exercise, maximum relative deoxygenation in the patients who had chronic compartment syndrome (mean relative deoxygenation [and standard error], -290 +/- 39 millivolts) was significantly greater than that in the patients who did not have chronic compartment syndrome (-190 +/- 10 millivolts) and that in the control subjects (-179 +/- 14 millivolts) (p < 0.05 for both comparisons). In addition, the interval between the cessation of exercise and the recovery of the pre-exercise resting level of oxygenation was significantly longer for the patients who had chronic compartment syndrome (184 +/- 54 seconds) than for the patients who did not have chronic compartment syndrome (39 +/- 19 seconds) and the control subjects (33 +/- 10 seconds) (p < 0.05 for both comparisons).
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المؤلفون: Michael Padilla, Samantha H Lee, Alan R. Hargens, John E. Lynch
المصدر: Journal of Orthopedics & Rheumatology.
مصطلحات موضوعية: Pathology, medicine.medical_specialty, Receiver operating characteristic, Pulse (signal processing), business.industry, Chemistry, Ultrasound, Area under the curve, Compartment Syndromes, Diagnostic test, medicine, Level ii, business, Nuclear medicine, Intramuscular pressure
الوصف: Background We tested a noninvasive ultrasound, Pulse Phase Locked Loop (PPLL) technique for estimating Intramuscular Pressure (IMP) in a model Acute Compartment Syndrome (ACS); and compared it to a Near-Infrared Spectroscopy (NIRS) method. Questions We wanted to validate our model compartment syndrome, and to compare and validate the PPLL and NIRS methods of detecting compartment syndrome. Methods To simulate the tamponade of an ACS, external-pressure levels from 10 to 70 mm Hg were applied to the legs of 15 healthy adult subjects to raise their IMP. Receiver Operator Characteristic (ROC) curves were used to determine the sensitivity and specificity of diagnosing elevated IMP by the two noninvasive techniques. Results NIRS data varied significantly with compression (p=0.003) with large subject-to-subject variability (p 30 mm Hg) were 0.75 and 0.75, respectively, and the area under the curve (AUC) was 0.78. For the NIRS, the sensitivity and specificity were 0.65 and 0.65, respectively, and the AUC was 0.68. Conclusions Both NIRS and PPLL recordings are able to differentiate a simulated ACS up to 70 mm Hg. However, the PPLL technique is a slightly better diagnostic predictor than NIRS with less subject-to-subject variability and slightly better sensitivity and specificity. Level of evidence Level II, Diagnostic test.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::89062190fc1207c9fd4e76c93ea802a4
https://doi.org/10.13188/2334-2846.1000005 -
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المؤلفون: Richard E. Ballard, Alan R. Hargens
المصدر: Operative Techniques in Sports Medicine. 3:237-242
مصطلحات موضوعية: medicine.medical_specialty, Compartment Syndromes, Catheterization, Muscle tone, Low frequency response, Internal medicine, Pressure, Transducers, Pressure, medicine, Fiber Optic Technology, Humans, Orthopedics and Sports Medicine, Muscle, Skeletal, Intramuscular pressure, Monitoring, Physiologic, Exertional compartment syndrome, business.industry, Surgery, Catheter, medicine.anatomical_structure, Needles, Clinical diagnosis, Cardiology, business, Tissue pressure
الوصف: We review historical and methodological approaches to measurements of intramuscular pressure (IMP) in humans. These techniques provide valuable measures of muscle tone and activity as well as diagnostic criteria for evaluation of exertional compartment syndrome. Although the wick and catheter techniques provide accurate measurements of IMP at rest, their value for exercise studies and diagnosis of exertional compartment syndrome is limited because of low frequency response and hydrostatic (static and inertial) pressure artifacts. Presently, most information on diagnosis of exertional compartment syndromes during dynamic exercise is available using the Myopress catheter. However, future research and clinical diagnosis using IMP can be optimized by the use of a miniature transducer-tipped catheter such as the Millar Mikro-tip.
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