jzs-10860

The Association between Clinical Features and Measurements of Intra-Compartmental Pressure in Diagnosis of Acute Compartment Syndrome of Closed Leg Fractures

Hamid Ahmad Mahmud Jaff 

Department of Surgery, College of Medicine, University of Sulaimani, Sulaimaniyah, Kurdistan Region, Iraq

Corresponding author E- mail: hamed.mahmood@univsul.edu.iq

DOI Link:https://doi.org/10.17656/jzs.10860

Abstract 

Objective: To find the clinical features of compartment syndrome and measurement of intra-compartmental pressure (ICP) in early diagnosis of the compartment syndrome of different types of closed leg bone fractures and their association with the severity of the fracture. Methodology: This prospective study included 20 patients with unilaterally closed fractures of the tibia and/or fibular fracture that presented to Shar Hospital, Sulaimaniyah City, Northern Iraq, from October 1st, 2018, to July 1st, 2020. Sociodemographic information with date and mechanism of injury, severity, side, and site of a fractured leg, and fracture's type according to Oestern and Tscherne classification of the close fracture were obtained. ICP was measured in the broken leg and normal leg at the time of admission to the emergency ward for patients using the needle-infusion technique (Whiteside's technique). Results: All patients were followed clinically by looking at features of the compartment for three days before the definitive treatment was established. We found that 8 out of 20 patients were complaining of severe, unusual pain (paresthesia) during follow-up. Acute compartment syndrome (ACS) was diagnosed in 1 (55-year-old man) out of 8 patients whose clinical features of compartment syndrome built up and with the differential pressure (∆p) of <30 mmHg. The cause of his fracture was a road traffic accident (RTA), and he underwent a fasciotomy. At the same time, the rest of the patients had no features of the compartment. Conclusions: We revealed a significant clinical correlation between the measurement of ICP and early detection and diagnosis of the post-traumatic ACS of the leg, and the measurement of ICP was valuable in the diagnosis of ACS and as a criterion for decompression. Also, this study shows a positive correlation between the type of fracture according to the Oestern and Tscherne classification and the increase in the measurement of the ICP

Key Words: Prospective study, Whiteside's technique, Intra-compartmental pressure, Acute compartment syndrome, Closed leg fractures.

References

[1] A. K. Tucker, "Chronic exertional compartment syndrome of the leg," Current Reviews in Musculoskeletal Medicine, vol. 3, pp. 32-37, 2010.

[2] M. Plancq, P. Buisson, F. Deroussen, G. Krim, L. Collet, and R. Gouron, "Successful early surgical treatment in neonatal compartment syndrome: case report," The Journal of Hand Surgery, vol. 38, pp. 1185-1188, 2013.

[3] B. S. Kalyani, B. E. Fisher, C. S. Roberts, and P. V. Giannoudis, "Compartment syndrome of the forearm: a systematic review," The Journal of Hand Surgery, vol. 36, pp. 535-543, 2011.

[4] A. G. Via, F. Oliva, M. Spoliti, and N. Maffulli, "Acute compartment syndrome," Muscles, Ligaments and Tendons Journal, vol. 5, p. 18, 2015.

[5] J. Pechar and M. M. Lyons, "Acute compartment syndrome of the lower leg: a review," The Journal for Nurse Practitioners, vol. 12, pp. 265-270, 2016.

[6] R. A. Buerba, N. F. Fretes, S. K. Devana, and J. J. Beck, "Chronic exertional compartment syndrome: current management strategies," Open Access Journal of Sports Medicine, vol. 10, p. 71, 2019.

[7] C. A. George and M. R. Hutchinson, "Chronic Exertional Compartment Syndrome," Clinics in sports medicine, vol. 31, pp. 307-319, 2012.

[8] R. S. Paik, D. Pepples, and M. R. Hutchinson, "Chronic Exertional Compartment Syndrome," Bmj, vol. 346, 2013.

[9] A. R. Diebal, R. Gregory, C. Alitz, and J. P. Gerber, "Forefoot running improves pain and disability associated with chronic exertional compartment syndrome," The American Journal of Sports Medicine, vol. 40, pp. 1060-1067, 2012.

[10] D. E. Davis, S. Raikin, D. N. Garras, P. Vitanzo, H. Labrador, and R. Espandar, "Characteristics of patients with chronic exertional compartment syndrome," Foot & Ankle International, vol. 34, pp. 1349-1354, 2013.

[11] A. H. Schmidt, "Acute compartment syndrome," Injury, vol. 48, pp. S22-S25, 2017.

[12] K. Saikia, T. Bhattacharya, and V. Agarwala, "Anterior compartment pressure measurement in closed fractures of leg," Indian Journal of Orthopaedics, vol. 42, p. 217, 2008.

[13] A. Yadav, J. Sikdar, V. Anand, R. Singh, and V. Sidhu, "Quantitative measurement of intra-compartmental pressure of the leg in acute traumatic injury: As a routine trend," Journal of Clinical Orthopaedics and Trauma, vol. 6, pp. 230-235, 2015.

[14] J. Erdös, C. Dlaska, P. Szatmary, M. Humenberger, V. Vécsei, and S. Hajdu, "Acute compartment syndrome in children: a case series in 24 patients and review of the literature," International Orthopaedics, vol. 35, pp. 569-575, 2011.

[15] B. Shadgan, G. Pereira, M. Menon, S. Jafari, W. D. Reid, and P. J. O’Brien, "Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults," Journal of Orthopaedics and Traumatology, vol. 16, pp. 185-192, 2015.

[16] M. Frink, F. Hildebrand, C. Krettek, J. Brand, and S. Hankemeier, "Compartment syndrome of the lower leg and foot," Clinical Orthopaedics and Related Research®, vol. 468, pp. 940-950, 2010.

[17] M. McQueen and C. Court-Brown, "Compartment monitoring in tibial fractures: the pressure threshold for decompression," The Journal of Bone and Joint Surgery. British Volume, vol. 78, pp. 99-104, 1996.

[18] D. H. Gershuni, S. J. Mubarak, N. C. Yaru, and Y.-F. Lee, "Fracture of the tibia complicated by acute compartment syndrome," Clinical Orthopaedics and Related Research, pp. 221-227, 1987.

[19] J. Heemskerk and P. Kitslaar, "Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies," World Journal of Surgery, vol. 27, pp. 744-747, 2003.

[20] J. Guo, Y. Yin, L. Jin, R. Zhang, Z. Hou, and Y. Zhang, "Acute compartment syndrome: Cause, diagnosis, and new viewpoint," Medicine, vol. 98, 2019.

[21] M. M. Heckman, T. E. Whitesides Jr, S. R. Grewe, and M. D. Rooks, "Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture," The Journal of Bone and Joint Surgery. American Volume, vol. 76, pp. 1285-1292, 1994.

[22] G. Mahran and M. Abbas, "Compartment syndrome: A cornerstone in critical care management," Journal of Anaesthesiology Critical Care, vol. 1, p. 2, 2017.

[23] S. A. Olson and R. R. Glasgow, "Acute compartment syndrome in lower extremity musculoskeletal trauma," JAAOS-Journal of the American Academy of Orthopaedic Surgeons, vol. 13, pp. 436-444, 2005.

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