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Sellei RM, Kobbe P, Pape HC, Hildebrand F. [Diagnostics of acute compartment syndrome : Current gold standard and the state of science of noninvasive assessment methods]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:529-538. [PMID: 38806712 DOI: 10.1007/s00104-024-02096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
Acute compartment syndrome (ACS) is defined by a disorder of the microcirculation due to a persistent pathological pressure increase within a muscle compartment. The ischemia of the tissue leads to an initially reversible functional impairment and finally irreversible damage of the musculature, nerves and other structures. Based on the understanding of the pathophysiology, the current diagnostic concepts and treatment using the so-called dermatofasciotomy of the affected muscle compartments can be derived. In addition to the suspicion of a possible ACS based on the medical history of the patient, the findings of the clinical examination are decisive. This review article gives a summary of all the essential aspects of the diagnostics. In clinically uncertain cases and for monitoring, an objectification of the findings using instrument-based techniques is increasingly required. Nowadays, invasive needle pressure measurement is available; however, due to limited reliability, specificity and sensitivity, these measurements only represent an aid to decision guidance supporting or advising against the indications for dermatofasciotomy. The increasing demands on making a certain diagnosis and justification of a surgical intervention from a legal point of view, substantiate the numerous scientific efforts to develop noninvasive instrument-based diagnostics. These methods are based either on detection of increasing intracompartmental pressure or decreasing perfusion pressure and microcirculation. The various measurement principles are summarized in a lucid form.
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Affiliation(s)
- Richard Martin Sellei
- Klinik für Unfallchirurgie und Orthopädische Chirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach am Main, Deutschland.
| | - Philipp Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle und Universitätsklinikum Halle, Halle, Deutschland
| | | | - Frank Hildebrand
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum der RWTH AACHEN, Aachen, Deutschland
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Hobbs M, Rahman HT, Raj R, Mandalaneni K, Pemminati S, Gorantla VR. Compartment Syndrome of the Lower Limb in Adults and Children and Effective Surgical Intervention and Post-surgical Therapies: A Narrative Review. Cureus 2024; 16:e63034. [PMID: 39050277 PMCID: PMC11268266 DOI: 10.7759/cureus.63034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Compartment syndrome (CS) can be defined as an acutely painful condition that occurs due to increased pressure within a compartment, resulting in reduced blood flow and oxygen to nerves and muscles within the limb. It is considered a surgical emergency, and a delayed diagnosis may result in ischemia and eventual necrosis of the limb. The majority of cases in adults are associated with high-energy trauma, more specifically, long bone fractures of the lower limb, while supracondylar fractures of the humerus are highly associated with CS in pediatric patients. CS may also develop gradually as a result of prolonged and ongoing physical activity such as running. In this narrative review, we discuss the anatomy, pathophysiology, methods of diagnosis, and effective management of CS in adults and children.
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Affiliation(s)
- Mikayla Hobbs
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Hira T Rahman
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Rhea Raj
- School of Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Kesava Mandalaneni
- Department of Neuroscience, St. George's University School of Medicine, St. George's, GRD
| | - Sudhakar Pemminati
- Department of Pharmacology, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Vasavi R Gorantla
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, USA
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Haidar A, Pauyo T, Harvey E, Drager J. Resolution of Confusion Over Compartment Syndrome After Tibial Osteotomy With Continuous Pressure Measurements. Cureus 2024; 16:e61114. [PMID: 38919242 PMCID: PMC11198222 DOI: 10.7759/cureus.61114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Compartment syndrome (CS) can occur in a variety of clinical scenarios. Reperfusion injury and tissue swelling are common causes across etiologies. Trauma is recognized as a common cause, but CS is also seen after limb alignment correction for extremities. CS is a difficult diagnosis to make in any scenario. Timely diagnosis is also difficult. Correct diagnosis is inexact, with many false positives and some false negatives being the normal outcome. This case represents a scenario where it was inherently difficult to make the diagnosis. The patient was a young patient with an underlying neurodevelopmental disorder where physical and clinical examination was impossible to accomplish. Any intervention to decrease pain was also difficult and actively refused by the patient and the family. Leaving open wounds after a fasciotomy was also undesirable for wound care and infection. Previous care maps have high false-positive rates or a need for fasciotomy as the treatment arm when diagnosis is uncertain. This usually results in fasciotomy being performed in many legs without CS. These false positives and resultant prophylactic releases are costly because of protracted hospital stay, high rate of deep infection, and decreased operating room availability for other cases. The desirable tool for surgeons would be the one that decreased false positives and false negatives while ensuring diagnosis in a timely fashion for true-positive cases. Technology for monitoring continuous pressure has been shown to aid in diagnosis. In this report, we illustrate the use of a continuous pressure monitoring system in a case of a pediatric patient post-osteotomy of a lower limb presenting with unremitting pain and a difficult clinical examination.
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Affiliation(s)
| | - Thierry Pauyo
- Orthopedic Surgery, McGill University, Montreal, CAN
| | - Edward Harvey
- Orthopedic Surgery, McGill University, Montreal, CAN
| | - Justin Drager
- Orthopedic Surgery, McGill University, Montreal, CAN
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Schupbach D, Reindl R, Gill HL, Liberman AS, Harvey EJ. Continuous Compartment Pressure Monitoring Allows the Early Detection of Compartment Syndrome After Arterial Revascularization. Cureus 2024; 16:e55451. [PMID: 38571834 PMCID: PMC10988544 DOI: 10.7759/cureus.55451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/05/2024] Open
Abstract
Compartment syndrome (CS) occurs in several clinical scenarios. Reperfusion injury and tissue swelling are common causes. This can occur after trauma but also is seen post revascularization of extremities. CS is a difficult diagnosis to make in a timely fashion that avoids permanent tissue damage. The treatment for CS is immediate fasciotomy, but fasciotomy is not a complication-free procedure. Previous care pathways usually resulted in fasciotomy being performed in a disproportionate number of normal legs. These false positives and prophylactic releases are costly to the health system because of protracted hospital stays and increased surgery numbers. The desirable tool for surgeons would be one that decreases false positives and negatives while ensuring a diagnosis in a timely fashion with true positives. A new technology that allows continuous pressure monitoring seems to be the best aid to make a diagnosis. We present our experience in decreasing the time to diagnosis in a CS case post revascularization despite the neurological blockade.
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Frane N, Doxey SA, Huyke-Hernández FA, Cunningham BP, McKee MD. Use of a Continuous Intracompartmental Pressure Monitoring Device During Fasciotomy. Orthopedics 2024; 47:e98-e101. [PMID: 37921525 DOI: 10.3928/01477447-20231027-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
A 52-year-old man presented with a bicondylar tibial plateau fracture and acute compartment syndrome. Continuous compartment pressure monitoring was used while the patient was treated with fasciotomies and application of an external fixator. The intraoperative pressure reading in the anterior compartment decreased from 105 mm Hg to 50 mm Hg after skin and subcutaneous tissue incision. Pressure continued to decrease to 10 mm Hg after all 4 compartments were released. The patient underwent staged open reduction and internal fixation and healed both fracture and fasciotomy incisions without complication. To our knowledge, this is the first report of continuous pressure changes during the different stages of a compartment release. Future studies could expand on use of this technology to gain information on compartment pressures during release and how single release affects pressures in other compartments. [Orthopedics. 2024;47(2):e98-e101.].
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Dean RS, Farley KX, Waterman BR, Guettler J, Bicos J. Chronic exertional compartment syndrome is frequently diagnosed through static compartment pressure measurements and managed with fasciotomy: A systematic review. J ISAKOS 2024; 9:71-78. [PMID: 37778507 DOI: 10.1016/j.jisako.2023.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Chronic exertional compartment syndrome (CECS) can be diagnosed either clinically or with intra-compartmental pressure monitor measurements and can be treated surgically or conservatively. METHODS A systematic review was performed on diagnostic and treatment modalities for CECS. Included studies were those that reported both their specific diagnostic modality and treatment regimens. Both surgical and conservative treatment strategies were considered. Demographic variables, diagnostic modalities, patient satisfaction and return to sport, the number of surgical incisions used for the anterior compartment fasciotomy, and the specific conservative treatment regimens were also recorded. Diagnostic modalities were grouped into one of three groups: 1) static compartment pressure monitor, 2) dynamic pressure monitoring, and 3) strictly clinical diagnosis. RESULTS The literature search identified 373 studies, of which 29 were included for final analysis. In total, there were 1270 total patients. Twenty-four studies used static compartment pressure monitors, 5 studies used dynamic pressure monitors and 2 studies used a strictly clinical diagnosis. Surgical management with fasciotomy was performed in 25 studies with a total of 1018 patients, while conservative management was used in 252 patients in 9 studies (5 studies included surgical and conservative treatments). Among surgical studies, 15 used a single-incision technique for anterior compartment fasciotomy, while 6 used a 2-incision technique. The reported satisfaction after fasciotomy was 42-94% while the return to sport was 26-100%. The reported return to sport in conservative management studies was 25-35%. CONCLUSION This systematic review found that the majority of clinical reports utilize static compartment pressure measurements to diagnose CECS, with fewer studies using dynamic intra-compartment pressure monitors. Additionally, surgical fasciotomy using a single-incision technique was the most common treatment strategy for anterior compartment CECC, with some studies reporting success with the two-incision technique. STUDY DESIGN Systematic review, level 4.
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Affiliation(s)
| | | | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, NC, 27103 USA
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Cavazos DR, Schultz R, Higginbotham DO, Goethals J, Vaidya R. Refractory compartment syndrome after antivenom administration for an Eastern Diamondback Rattlesnake bite requiring fasciotomy for limb salvage: A case report. Trauma Case Rep 2023; 46:100852. [PMID: 37274542 PMCID: PMC10238865 DOI: 10.1016/j.tcr.2023.100852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/06/2023] Open
Abstract
Case 56-year-old male who developed post-snakebite compartment syndrome (PSCS) of the upper extremity which was refractory to antivenom administration. He had elevated compartment pressure measurements in his upper extremity. He underwent open fasciotomy for the compartment syndrome, followed by delayed primary closure and skin grafting. He now has two years of follow-up with a functional upper extremity. Conclusion This is a case of a patient who suffered post-snakebite compartment syndrome from his pet Eastern Diamondback Rattlesnake. This case highlights the importance of correctly diagnosing compartment syndrome and validates fasciotomy as a treatment measure for confirmed post-snakebite compartment syndrome (PSCS).
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Affiliation(s)
- Daniel R Cavazos
- Detroit Medical Center, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Devan O Higginbotham
- Detroit Medical Center, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Rahul Vaidya
- Detroit Medical Center, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
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Sharma N, Sharma NM, Sharma A, Mirza S. Comparison and convergence of compartment syndrome techniques: a narrative review. Expert Rev Med Devices 2023; 20:283-291. [PMID: 37083118 DOI: 10.1080/17434440.2023.2206020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Compartment syndrome (CS) continues to be a legitimate orthopedic emergency as it leads to thousands of amputations and permanent nerve and tissue damage to undiagnosed patients for more than eight hours. In CS, intracompartmental pressure is elevated, causing reduced blood flow inside the limb compartments. An erroneous diagnosis may result in unnecessary fasciotomies, the only treatment for this condition. AREAS COVERED This review examines the previous and current diagnostic and therapeutic practices for compartment syndrome. It also performs a comparative analysis of each diagnostic technique and its foresights. EXPERT OPINION Currently, most clinicians rely on a physical examination of the patient to diagnose CS. The primary reason for the physical examination is the lack of a gold-standard device. The invasive intracompartmental pressure (ICP) measurement technique is still the most commonly used. On the other hand, many non-invasive approaches have the potential to be used as diagnostic tools; however, more research is needed before they can be accepted as standard clinical approaches.
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Affiliation(s)
- Naveen Sharma
- CSIR-Central Scientific Instruments Organization, Chandigarh, 160030, India
| | - Nitin Mohan Sharma
- CSIR-Central Scientific Instruments Organization, Chandigarh, 160030, India
| | - Apurva Sharma
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Sarfaraj Mirza
- CSIR-Central Scientific Instruments Organization, Chandigarh, 160030, India
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Porcine Model of Acute Compartment Syndrome. J Orthop Trauma 2023; 37:e122-e127. [PMID: 36219778 DOI: 10.1097/bot.0000000000002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Acute compartment syndrome is a devastating condition associated with lasting consequences or even death if not treated in a timely fashion. Current preclinical modeling is inadequate. Ideally a model should mimic human disease. There should be a trauma-induced reperfusion or direct muscle event that causes gradual increased pressure and is amenable to release with fasciotomy. We have attempted to reproduce this mechanism and outcome in a porcine model. METHODS Anterior tibial musculature was injured with vascular occlusion plus exterior tourniquet crush or direct intracompartmental crush through balloon inflation. The injury was maintained for over 5 hours. At that time, the tourniquet or balloon was removed. The injuries were continuously monitored with an intramuscular continuous pressure sensor. Pressure changes were recorded and after 2 hours of postinjury observation, a fasciotomy was performed for the muscle compartment. RESULTS Pressures were brought to 100 mm Hg during the injury phase. During the two-hour observation period, the balloon catheter technique achieved an average pressure of 25.1 ± SD 8.8 mm Hg with a maximum reading of 38.2 mm Hg and minimum reading of 14.1 mm Hg. During this same period, the ischemia-reperfusion + direct crush technique achieved an average pressure of 33.7 ± SD 7.3 mm Hg, with a maximum reading of 43.5 mm Hg and minimum reading of 23.5 mm Hg. Average pressure postfasciotomy for the balloon catheter technique was 2.4 ± SD 2.5 mm Hg; and for the crush technique, average value postfasciotomy was 4.9 ± SD 3.7 mm Hg-both representing a return to physiologic levels. CONCLUSION This is the first preclinical model that shows the same response to injury and treatment as is observed in human physiology. Surgical and nonsurgical therapies for compartment syndrome can now be tested reliably.
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10
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Wang T, Guo J, Long Y, Hou Z. Predictors of acute compartment syndrome in patients with tibial fractures: a meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:51-65. [PMID: 36450888 DOI: 10.1007/s00264-022-05643-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/12/2022] [Indexed: 12/04/2022]
Abstract
STUDY DESIGN This is the first meta-analysis focusing on the risk factors related to ACS after tibial fractures. BACKGROUND Acute compartment syndrome (ACS) is a serious complication that affects 2-9% of tibial fracture patients. It is importance of identifying the predictors of ACS in patients with tibial fractures. QUESTIONS/PURPOSES We performed a meta-analysis to identify the risk factors of ACS after tibial fracture. METHODS We searched articles in the English databases, such as PubMed, Embase, and the Cochrane Library and the Chinese databases including CNKI and WAN FANG. We collected data related to ACS from included studies and analyzed data by RevMan 5.3 and STATA 12.0. RESULTS The rate of ACS was 2.7% (10,708 of 398,414 patients) from 16 included articles. Our data showed that younger age (p < 0.00001, OR = - 7.93, 95% CI [- 9.34, - 6.25]), male patients (p < 0.00001, OR = 2.17, 95% CI [2.07, 2.28]), patients without a history of hypertension (p < 0.00001, OR = 0.69, 95% CI [0.64, 0.74]), with a history of smoking (p < 0.00001, OR = 1.38, 95% CI [1.30, 1.46]), and patients with fibular fractures (p = 0.001, OR = 2.68, 95% CI [1.47, 4.87]), closed fracture (p = 0.02, OR = 0.86, 95% CI [0.75, 0.98]), high-energy injury (p = 0.003, OR = 0.37, 95% CI [0.19, 0.71]), motorized accident (p = 0.0009, OR = 0.41, 95% CI [0.24, 0.69]), proximal fracture, AO-C-type fracture, comminuted fracture, and Schatzker grade IV-VI fracture were associated with the development of ACS. Additionally, femoral displacement ratio and tibial widening ratio in the ACS groups were significantly higher than in the non-ACS group. CONCLUSION Many factors were found to be associated with the development of ACS following tibial fractures. We provide references when we met the above characteristics of patients to rapidly identify and highly concern ACS.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yubin Long
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Westman AM, Guo H, Xu Y, Bai W, Liu Y, Ouyang W, Moritz W, Jacobson L, Weng Y, Zang H, Wu C, Hu Z, Li S, Lu D, Arafa HM, MacEwan MR, Tatman L, Rogers JA, Pet MA. Percutaneously introduced wireless intramuscular near-infrared spectroscopy device detects muscle oxygenation changes in porcine model of lower extremity compartment syndrome. J Orthop Res 2023; 41:54-62. [PMID: 35384025 DOI: 10.1002/jor.25339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/15/2022] [Accepted: 03/31/2022] [Indexed: 02/07/2023]
Abstract
Serial examination and direct measurement of intracompartmental pressure (ICP) are suboptimal strategies for the detection of acute compartment syndrome (CS) because they are operator-dependent and yield information that only indirectly reflects intracompartmental muscle perfusion. As a result, instances of unnecessary fasciotomy and unrecognized CS are relatively common. Recently, near-infrared spectroscopy (NIRS)-based systems for compartment monitoring have generated interest as an adjunct tool. Under ideal conditions, NIRS directly measures the oxygenation of intracompartmental muscle (StO2 ), thereby obviating the challenges of interpreting equivocal clinical examination or ICP data. Despite these potential advantages, existing NIRS sensors are plagued by technical difficulties that limit clinical utility. Most of these limitations relate to their transcutaneous design that makes them susceptible to both interference from intervening skin/subcutaneous tissue, underlying hematoma, and instability of the skin-sensor interface. Here, we present a flexible, wireless, Bluetooth-enabled, percutaneously introducible intramuscular NIRS device that directly and continuously measures the StO2 of intracompartmental muscle. Proof of concept for this device is demonstrated in a swine lower extremity balloon compression model of acute CS, wherein we simultaneously track muscle oxygenation, ICP, and compartment perfusion pressure (PP). The observed StO2 decreased with increasing ICP and decreasing PP and then recovered following pressure reduction. The mean change in StO2 as the PP was decreased from baseline to 30 mmHg was -7.6%. The mean difference between baseline and nadir StO2 was -17.4%. Cross-correlations (absolute value) describing the correspondence between StO2 and ICP were >0.73. This novel intramuscular NIRS device identifies decreased muscle perfusion in the setting of evolving CS.
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Affiliation(s)
- Amanda M Westman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Hexia Guo
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - Yameng Xu
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Wubin Bai
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yiming Liu
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - Wei Ouyang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - William Moritz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Lauren Jacobson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Yang Weng
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois, USA
| | - Hao Zang
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois, USA
| | - Changsheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - Ziying Hu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - Shuo Li
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - Di Lu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA
| | - Hany M Arafa
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Matthew R MacEwan
- Department of Neurosurgery, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Lauren Tatman
- Division of Trauma Surgery, Department of Orthopaedic Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA
| | - John A Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois, USA.,Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Chemistry, Northwestern University, Evanston, Illinois, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Electrical and Computer Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, Missouri, USA
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Merle G, Miclau T, Parent-Harvey A, Harvey EJ. Sensor technology usage in orthopedic trauma. Injury 2022; 53 Suppl 3:S59-S63. [PMID: 36182592 DOI: 10.1016/j.injury.2022.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 02/02/2023]
Abstract
Medicine in general is quickly transitioning to a digital presence. Orthopaedic surgery is also being impacted by the tenets of digital health but there are also direct efforts with trauma surgery. Sensors are the pen and paper of the next wave of data acquisition. Orthopaedic trauma can and will be part of this new wave of medicine. Early sensor products that are now coming to market, or are in early development, will directly change the way we think about surgical diagnosis and outcomes. Sensor development for biometrics is already here. Wellness devices, pressure, temperature, and other parameters are already being measured. Data acquisition and analysis is going to be a fruitful addition to our research armamentarium with the volume of information now available. A combination of broadband internet, micro electrical machine systems (MEMS), and new wireless communication standards is driving this new wave of medicine. The Internet of Things (IoT) [1] now has a subset which is the Internet of Medical Devices [2-5] permitting a much more in-depth dive into patient procedures and outcomes. IoT devices are now being used to enable remote health monitoring, in hospital treatment, and guide therapies. This article reviews current sensor technology that looks to impact trauma care.
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Affiliation(s)
- Géraldine Merle
- École Polytechnique de Montréal, Université de Montréal, Montréal, Canada
| | - Theodore Miclau
- Orthopaedic Trauma Institute, University of Calfornia, School of Medicine, Department of Orthopaedics, San Francisco, USA
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13
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Montreuil J, Corban J, Reindl R, Harvey EJ, Bernstein M. Novel digital continuous sensor for monitoring of compartment pressure: a case report. OTA Int 2022; 5:e208. [PMID: 36425093 PMCID: PMC9580258 DOI: 10.1097/oi9.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/20/2022] [Indexed: 06/16/2023]
Abstract
Case The American Academy of Orthopaedic Surgeons has recently identified continuous intracompartmental pressure monitoring as 1 of the few means to assist in ruling out acute compartment syndrome (ACS). There are very few methods that allow this measurement. This manuscript describes the use of a new digital monitoring system for ACS in 3 patients. This minimally invasive device, the MY01 (NXTSENS, Montreal, Canada) is capable of continuously and precisely measuring variations in intracompartmental pressure. Conclusion MY01 detected the occurrence of ACS at early-stage and expedited the timing of surgery for 2 patients. This tool also objectively excluded a suspected diagnosis of ACS in a medically comorbid patient, obviating the need for unnecessary fasciotomies and potential complications.
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Affiliation(s)
- Julien Montreuil
- Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jason Corban
- Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Rudolf Reindl
- Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Edward J Harvey
- Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Bouklouch Y, Schmidt AH, Obremskey WT, Bernstein M, Gamburg N, Harvey EJ. Big data insights into predictors of acute compartment syndrome. Injury 2022; 53:2557-2561. [PMID: 35249740 DOI: 10.1016/j.injury.2022.02.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND There remain gaps in knowledge regarding the pathophysiology, initial diagnosis, treatment, and outcome of acute compartment syndrome (ACS). Most reported clinical outcomes are from smaller studies of heterogeneous patients. For a disease associated with a financial burden to society that represents billions of dollars worldwide the literature does not currently establish baseline diagnostic parameters and risk factors that may serve to predict treatment and outcomes. METHODS This study looks at a very large cohort of trauma patients obtained from four recent years of the Trauma Quality Programs data from the American College of Surgeons. From 3,924,127 trauma cases - 203,500 patients with tibial fractures were identified and their records examined for demographic information, potential risk factors for compartment syndrome, an associated coded diagnosis of muscle necrosis, and presence of other outcomes associated with compartment syndrome. A recurrent multiple logistic regression model was used to identify factors predictive of fasciotomy. The results were compared to the reported results from the literature to validate the findings. RESULTS The rate of fasciotomy treatment for ACS was 4.3% in the cohort of identified patients. The analysis identified several clinical predictors of fasciotomy. Proximal and midshaft tibial fractures (P <0.0001) showed highest increases in the likelihood of ACS. Open fractures were twice (O.R [2.20-2.42]) as likely to have ACS. Having a complex fracture (P<0.0001), substance abuse disorder (P<0.0002), cirrhosis (P = 0.002) or smoking (P<0.0051) all increased the likelihood of ACS. Age decreased the likelihood by 1% per year (OR= [0.99-0.993]). Crush and penetrating injuries showed an important increase in the likelihood of ACS (O.R of 1.83 and 1.37 respectively). Additionally, sex, BMI, cirrhosis, tobacco smoking and fracture pattern as defined by OTA group and OTA subgroup had predictive value on actual myonecrosis. Fasciotomies for open tibial fractures were more likely to uncover significant muscle necrosis compared to closed fractures. Amputation resulted after 5.4% of fasciotomies. CONCLUSION This big data approach shows us that ACS is primarily linked to the extent of soft tissue damage. However, newfound effect of some comorbidities like cirrhosis and hypertension on the risk of ACS imply other mechanisms.
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Affiliation(s)
| | | | - William T Obremskey
- Department of Orthopaedic Surgery Vanderbilt Medical Center, Vanderbilt Center for Musculoskeletal Research
| | - Mitchell Bernstein
- McGill University Health Center - Research Institute; McGill University Department of Surgery, Division of Orthopaedic Surgery
| | | | - Edward J Harvey
- McGill University Health Center - Research Institute; McGill University Department of Surgery, Division of Orthopaedic Surgery.
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Nasser Eddine M, Schupbach DE, Honjol Y, Merle G, Harvey EJ. Minimal Percutaneous Release for Acute Compartment Syndrome of the Foot: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00038. [PMID: 36075019 DOI: 10.2106/jbjs.cc.21.00484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 34-year-old man had an injury which resulted in pilon fracture and acute compartment syndrome of his forefoot. The case report describes the use of a novel minimally invasive dorsal approach for decompression of the lateral, central, medial, and interosseous compartments. The release was performed through multiple small incisions on the dorsal foot. The patient had complete relief with normal function of all muscle groups at 6 weeks and is now 18 months after surgery. He has returned to full activity. CONCLUSION The successful decompression of the forefoot compartments through a percutaneous approach avoided known complications of muscle death, toe clawing, and secondary surgeries.
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Affiliation(s)
- Mohamad Nasser Eddine
- Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Drew E Schupbach
- Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Yazan Honjol
- Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Geraldine Merle
- Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- Department of Chemical Engineering, Polytechnique Montreal, chemin de Polytechnique, Montréal, Quebec, Canada
- Injury Repair and Recovery Program, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Edward J Harvey
- Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- Injury Repair and Recovery Program, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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Schupbach D, Honjol Y, Bouklouch Y, Merle G, Harvey EJ. Acute Compartment Syndrome Modeling with Sequential Infusion Shows the Deep Posterior Compartment Is Not Functionally Discrete. J Bone Joint Surg Am 2022; 104:813-820. [PMID: 35041625 DOI: 10.2106/jbjs.21.00291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical case series have indicated that 1 or 2-compartment decompression of the anterior or lateral leg may be sufficient for release, but, currently, no cadaveric model has verified that approach. The objective of this study was to investigate the functional relationship between compartments by alternating sequences of infusion and fasciotomy release. METHODS This study utilized multicompartment sequential pressurization with simultaneous monitoring by continuous pressure sensors to model compartment syndrome in a human cadaver leg. Subsequent sequential release of compartments and continuous streaming of pressure readings permitted unique insights. RESULTS A leg model allowed the examination of pressure changes in all 4 compartments as treated with sequential fasciotomies. The successful modeling of lower-leg pressures consistent with compartment syndrome showed that discrepancies relative to accepted concepts were seen when the deep posterior compartment was pressurized in isolation. Also, release of 1 of the 2 of either the anterior or lateral compartments seems to be sufficient for decompression to acceptable pressure levels. CONCLUSIONS The deep posterior compartment does not appear to be completely discrete and instead follows the pressurization curve of the posterior muscle group. This indicates that release of the deep posterior compartment may not be needed in all acute compartment syndrome scenarios. CLINICAL RELEVANCE Surgical techniques can be modified for treatment of acute compartment syndrome to avoid large scar lengths, deep dissection, and multiple exposures that could improve patient outcomes.
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Affiliation(s)
- Drew Schupbach
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada.,Experimental Surgery Program, McGill University, Montreal, Quebec, Canada
| | - Yazan Honjol
- Experimental Surgery Program, McGill University, Montreal, Quebec, Canada
| | - Yasser Bouklouch
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Geraldine Merle
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
| | - Edward J Harvey
- Department of Surgery, Injury Repair Recovery Program, McGill University Health Center Research Institute, McGill University, Montreal, Quebec, Canada
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Abstract
Digital health principles are starting to be evident in medicine. Orthopaedic trauma surgery is also being impacted —indirectly by all other improvements in the health ecosystem but also in particular efforts aimed at trauma surgery. Data acquisition is changing how evidence is gathered and utilized. Sensors are the pen and paper of the next wave of data acquisition. Sensors are gathering wide arrays of information to facilitate digital health relevance and adoption. Early adaption of sensor technology by the nonlegacy health environment is what has made sensor driven data acquisition so palatable to the normal health care system. As it applies to orthopaedic trauma, current sensor driven diagnostics and surveillance are nowhere near as developed as in the larger medical community. Digital health is being explored for health care records, data acquisition in diagnostics and rehabilitation, wellness to health care translation, intraoperative monitoring, surgical technique improvement, as well as some early-stage projects in long-term monitoring with implantable devices. The internet of things is the next digital wave that will undoubtedly affect medicine and orthopaedics. Internet of things (loT) devices are now being used to enable remote health monitoring and emergency notification systems. This article reviews current and future concepts in digital health that will impact trauma care.
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Schupbach DE, Nasser Eddine M, Honjol Y, Merle G, Harvey EJ. Percutaneous Forefoot Decompression in a Foot Compartment Syndrome Model. JB JS Open Access 2021; 6:JBJSOA-D-21-00040. [PMID: 34841190 PMCID: PMC8613368 DOI: 10.2106/jbjs.oa.21.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acute compartment syndrome of the foot is a controversial topic. Release of the foot has been seen as complicated because of large incisions and postoperative morbidity, and there has been debate over whether this procedure is actually effective for releasing all areas of increased pressure. New sensor technology affords the opportunity to advance our understanding of acute compartment syndrome of the foot and its treatment. The purpose of the present study was to determine whether percutaneous decompression could be performed for the treatment of compartment syndrome in a forefoot model.
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Affiliation(s)
- Drew E Schupbach
- Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mohamad Nasser Eddine
- Department of Surgery, Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Yazan Honjol
- Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Geraldine Merle
- Department of Surgery, Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.,Department of Chemical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada
| | - Edward J Harvey
- Department of Surgery, Division of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada.,Injury Repair and Recovery Program, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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