A dual-sensor ultrasound based method for detecting elevated muscle compartment pressures: A prospective clinical pilot study. Issue 8 (August 2021)

• Record Type: Journal Article
• Authors: Marmor, Meir T.; Barker, Jordan P.; Matz, Jacob; Donohoe, Erin; Herring, Matthew J.
• Is Part Of: Injury. Volume 52:Issue 8(2021)
• Page Start: 2166
• Page End: 2172
• Publication Date: 2021-08
• Subjects: Acute compartment syndrome -- Muscle compartment pressure -- Ultrasound; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.02.054
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: A dual-sensor approach can allow readily available ultrasound-based technology to non-invasively measure elevated compartment pressures. The described non-invasive dual-sensor ultrasound measurements may be able to confirm need for fasciotomy in the setting of suspected compartment syndrome. The dual-sensor technique for measurement of elevated muscle compartment pressure can be performed by clinicians without previous training in musculoskeletal ultrasound. Single (Injured) leg measurements are sufficient. Comparison to the uninjured side may not be necessary. Abstract: Background: Acute compartment syndrome (ACS) is a limb-threatening condition associated with elevated muscle compartment pressures (MCPs). The only existing treatment of ACS is to reduce MCP by fasciotomy; however, a reliable clinical method for detecting elevated MCPs is lacking. A dual-sensor (ultrasound and pressure) technology to detect elevated MCPs was previously tested on cadavers. Our goal was to examine the use of this technology in the clinical setting. Methods: Patients with tibia fractures were prospectively enrolled. Observers used a dual-sensor probe to measure the amount of pressure required to flatten the anterior compartment fascia (CFFP). Direct-MCP measurements and 4-compartment fasciotomy were done for suspected ACS. Results: Fifty-two patients were enrolled into the study. Nine patients underwent fasciotomy for a clinical diagnosis of ACS. Both CFFP (p-value = 8.395e-08) and delta-CFFP (p-value = 4.114e-05) were significantly larger in the fasciotomy group compared to the non-fasciotomy group. CFFP measurements showed very strong correlations to the direct MCP measurements (p-value = 0.006746, rho = 0.9285714), and delta-CFFP showed strong correlation (p-value = 0.06627, rho = 0.75). CFFP measurements had good inter-observer variability, with an interclass correlation (ICC) of 0.814 (95%-Confidence Interval: 0.631-0.907) and excellent intra-observer variability with an ICC of 0.942 (95%-Confidence Interval: 0.921-0.958). Conclusion: The results of this pilot study suggest that the proposed ultrasound-based method is useful in detecting elevated MCPs and may be helpful in the diagnosing ACS or ruling out the need for urgent fasciotomy. Large-scale clinical trials are needed to validate these claims.