Feasibility of ultrasound measurement in a human model of acute compartment syndrome
Abstract Background Early diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward....
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-02-01
|
| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13017-019-0222-9 |
| _version_ | 1818423207630209024 |
|---|---|
| author | Jakob Mühlbacher Reinhard Pauzenberger Ulrika Asenbaum Tobias Gauster Stephan Kapral Harald Herkner Andreas Duma |
| author_facet | Jakob Mühlbacher Reinhard Pauzenberger Ulrika Asenbaum Tobias Gauster Stephan Kapral Harald Herkner Andreas Duma |
| author_sort | Jakob Mühlbacher |
| collection | DOAJ |
| description | Abstract Background Early diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward. The purpose of this exploratory study was to investigate the feasibility of non-invasive ultrasound-guided angle measurement as a surrogate of increased pressure in a model of ACS. Methods A model of ACS was generated by infusion of saline into the anterior compartment of the leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers), the angle (TFA, tibia-fascia angle) between the anterolateral cortex of the tibia and the fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. A multilevel linear regression model was used to estimate intracompartmental pressure from delta TFA (ΔTFA). Results TFA (mean [± SD]) increased from 61.0° (± 12.0°) at 10 mmHg up to 81.1° (± 11.1°) at 100 mmHg compartment pressure. Each increase ΔTFA by one degree was associated with an increase in pressure by 3.9 mmHg (95% CI, 3.8–4.0, p < 0.001). Conclusions We found that intracompartmental pressure of the anterior compartment of the calf can be well estimated by ultrasound-based ΔTFA in this post mortem experiment. Our findings indicate that non-invasive TFA measurement is feasible and it is reasonable that this will hold true in real life, but the findings are too preliminary to be used in clinical practice now. |
| first_indexed | 2024-12-14T13:38:29Z |
| format | Article |
| id | doaj.art-da49a28e16e041b5be06fb9ff82b0f34 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-14T13:38:29Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-da49a28e16e041b5be06fb9ff82b0f342022-12-21T22:59:31ZengBMCWorld Journal of Emergency Surgery1749-79222019-02-011411710.1186/s13017-019-0222-9Feasibility of ultrasound measurement in a human model of acute compartment syndromeJakob Mühlbacher0Reinhard Pauzenberger1Ulrika Asenbaum2Tobias Gauster3Stephan Kapral4Harald Herkner5Andreas Duma6Department of Surgery, Division of General Surgery, Medical University of ViennaDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of ViennaDepartment of Biomedical Imaging and Image-guided Therapy, Medical University of ViennaInstitute of Applied Statistics and Computing, University of Natural Resources and Life SciencesDepartment of Anaesthesiology and Intensive Care, AUVADepartment of Emergency Medicine, Medical University of ViennaDepartment of Anaesthesiology and General Intensive Care, Medical University of ViennaAbstract Background Early diagnosis of acute compartment syndrome (ACS) of the leg is essential to improve the outcome. Direct invasive measurement is currently recommended to measure intracompartmental pressure. A non-invasive and reproducible means of making the diagnosis would be a step forward. The purpose of this exploratory study was to investigate the feasibility of non-invasive ultrasound-guided angle measurement as a surrogate of increased pressure in a model of ACS. Methods A model of ACS was generated by infusion of saline into the anterior compartment of the leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers), the angle (TFA, tibia-fascia angle) between the anterolateral cortex of the tibia and the fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. A multilevel linear regression model was used to estimate intracompartmental pressure from delta TFA (ΔTFA). Results TFA (mean [± SD]) increased from 61.0° (± 12.0°) at 10 mmHg up to 81.1° (± 11.1°) at 100 mmHg compartment pressure. Each increase ΔTFA by one degree was associated with an increase in pressure by 3.9 mmHg (95% CI, 3.8–4.0, p < 0.001). Conclusions We found that intracompartmental pressure of the anterior compartment of the calf can be well estimated by ultrasound-based ΔTFA in this post mortem experiment. Our findings indicate that non-invasive TFA measurement is feasible and it is reasonable that this will hold true in real life, but the findings are too preliminary to be used in clinical practice now.http://link.springer.com/article/10.1186/s13017-019-0222-9Acute compartment syndromeUltrasoundLower extremityHuman cadaver |
| spellingShingle | Jakob Mühlbacher Reinhard Pauzenberger Ulrika Asenbaum Tobias Gauster Stephan Kapral Harald Herkner Andreas Duma Feasibility of ultrasound measurement in a human model of acute compartment syndrome World Journal of Emergency Surgery Acute compartment syndrome Ultrasound Lower extremity Human cadaver |
| title | Feasibility of ultrasound measurement in a human model of acute compartment syndrome |
| title_full | Feasibility of ultrasound measurement in a human model of acute compartment syndrome |
| title_fullStr | Feasibility of ultrasound measurement in a human model of acute compartment syndrome |
| title_full_unstemmed | Feasibility of ultrasound measurement in a human model of acute compartment syndrome |
| title_short | Feasibility of ultrasound measurement in a human model of acute compartment syndrome |
| title_sort | feasibility of ultrasound measurement in a human model of acute compartment syndrome |
| topic | Acute compartment syndrome Ultrasound Lower extremity Human cadaver |
| url | http://link.springer.com/article/10.1186/s13017-019-0222-9 |
| work_keys_str_mv | AT jakobmuhlbacher feasibilityofultrasoundmeasurementinahumanmodelofacutecompartmentsyndrome AT reinhardpauzenberger feasibilityofultrasoundmeasurementinahumanmodelofacutecompartmentsyndrome AT ulrikaasenbaum feasibilityofultrasoundmeasurementinahumanmodelofacutecompartmentsyndrome AT tobiasgauster feasibilityofultrasoundmeasurementinahumanmodelofacutecompartmentsyndrome AT stephankapral feasibilityofultrasoundmeasurementinahumanmodelofacutecompartmentsyndrome AT haraldherkner feasibilityofultrasoundmeasurementinahumanmodelofacutecompartmentsyndrome AT andreasduma feasibilityofultrasoundmeasurementinahumanmodelofacutecompartmentsyndrome |