Injury · 2021
A dual-sensor ultrasound based method for detecting elevated muscle compartment pressures: A prospective clinical pilot study.
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Marmor Meir T, Barker Jordan P, Matz Jacob, Donohoe Erin, Herring Matthew J
Аннотация
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.
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.