Compartment elasticity measured by pressure-related ultrasound to determine patients “at risk” for compartment syndrome: an experimental in vitro study

Patient Safety in Surgery

Hans-Christoph Pape²  Frank Hildebrand²  Sabine Jeromin³  Frauke Zimmerman³  John Edward Grice⁴  Christian Weber²  Philipp Kobbe²  Simon Johannes Hingmann²  Richard Martin Sellei¹ 

[1] Department of Orthopaedic Trauma, Sana Klinikum Offenbach am Main, Offenbach am Main, Germany;Department of Orthopaedic Trauma, Aachen University Medical Center, Aachen, Germany;Helmholtz-Institute for biomedical engineering, Chair of medical engineering, RWTH Aachen University, Aachen, Germany;Department of Orthopaedics and Trauma, Queen Alexandra Hospital, Portsmouth, UK

关键词: Elastography;    Elasticity measurement;    Non-invasive diagnostic;    Intra-compartmental pressure;    Compartment syndrome;   

Others  :  1132116
DOI  :  10.1186/s13037-014-0051-4

 received in 2014-10-30, accepted in 2014-12-17,  发布年份 2015

【 摘 要 】

Background

Decision-making in treatment of an acute compartment syndrome is based on clinical assessment, supported by invasive monitoring. Thus, evolving compartment syndrome may require repeated pressure measurements. In suspected cases of potential compartment syndromes clinical assessment alone seems to be unreliable. The objective of this study was to investigate the feasibility of a non-invasive application estimating whole compartmental elasticity by ultrasound, which may improve accuracy of diagnostics.

Methods

In an in vitro model, using an artificial container simulating dimensions of the human anterior tibial compartment, intra-compartmental pressures (p) were raised subsequently up to 80 mmHg by infusion of saline solution. The compartmental depth (mm) in the cross-section view was measured before and after manual probe compression (100 mmHg) upon the surface resulting in a linear compartmental displacement (∆d). This was repeated at rising compartmental pressures. The resulting displacements were related to the corresponding intra-compartmental pressures simulated in our model. A hypothesized relationship between pressures related compartmental displacement and the elasticity at elevated compartment pressures was investigated.

Results

With rising compartmental pressures, a non-linear, reciprocal proportional relation between the displacement (mm) and the intra-compartmental pressure (mmHg) occurred. The Pearson coefficient showed a high correlation (r² = −0.960). The intra-observer reliability value kappa resulted in a statistically high reliability (κ = 0.840). The inter-observer value indicated a fair reliability (κ = 0.640).

Conclusions

Our model reveals that a strong correlation between compartmental strain displacements assessed by ultrasound and the intra-compartmental pressure changes occurs. Further studies are required to prove whether this assessment is transferable to human muscle tissue. Determining the complete compartmental elasticity by ultrasound enhancement, this application may improve detection of early signs of potential compartment syndrome.

【 授权许可】

   
2015 Sellei et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Finkelstein J, Hunter G, Hu R: Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma 1996, 40:342-344.
• [2]McQueen MM, Gaston P, Court-Brown CM: Acute compartment syndrome. Who is t risk? J Bone Joint Surg (Br) 2000, 82:200-3.
• [3]McQueen MM, Christie J, Court-Brown CM: Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg (Br) 1996, 78:95-98.
• [4]Rorabeck CH: The treatment of compartment syndrome of the leg. J Bone Joint Surg (Br) 1984, 66:93-7.
• [5]Olson SA, Rhorer AS: Orthopaedic trauma for the general orthopaedist. Avoiding problems and pitfalls in treatment. Clin Orthop Relat Res 2005, 433:30-37.
• [6]Templeman D, Lange R, Harms B: Lower-extremity compartment syndromes associated with use of pneumatic antishock garments. J Trauma 1987, 27:79-81.
• [7]Matsen FA 3rd: Compartment syndromes: a unified concept. Clin Orthop 1975, 113:8-14.
• [8]Whiteside TE, Haney TC, Harada H, Homles HE, Morimoto K: A simple method for tissue pressure determination. Arch Surg 1975, 110:1311-13.
• [9]Shuler MS, Reisman WM, Kinsey TL, Whitesides TE Jr, Hammerberg EM, Davila MG, et al.: Correlation between muscle oxygenation and compartment pressure in acute compartment syndrome of the leg. J Bone Joint Surg Am 2010, 92:863-870.
• [10]Shadgan B, Menon M, O’Brien PJ, Reid WD: Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma 2008, 22:581-587.
• [11]Arokoski JPA, Surakka J, Ojala T, Arokoski JP, Surakka J, Ojala T, Kolari P, Jurvelin JS: Feasibility of the use of a novel soft tissue stiffness meter. Physiol Meas 2005, 26:215-228.
• [12]Dickson KF, Sullivan MJ, Steinberg B: Noninvasive measurement of compartment syndrome. Orthopedics 2003, 26:1215-1218.
• [13]Steinberg BD: Evaluation of limb compartments with increased interstitial pressure. An improved noninvasive method for determining quantitative hardness. J Biomech 2005, 38:1629-1635.
• [14]Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X: Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrasound Imaging 1991, 13:111-134.
• [15]Lerner RM, Huang SR, Parker KJ: “Sonoelasticity” images derives from ultrasound signals in mechanically vibrated tissues. Ultrasound Med Biol 1990, 16:231-39.
• [16]Garra BS: Imaging and estimation of tissue elasticity by ultrasound. Ultrasound 2007, 23:255-68.
• [17]Park GY, Kwon DR: Application of real-time sonoelastography in musculoskeletal diseases related to physical medicine and rehabilitation. Am J Phys Med Rehabil 2011, 90:875-86.
• [18]Niitsu M, Michizaki A, Endo A, Niitsu M, Michizaki A, Endo A, Takei H, Yanagisawa O: Muscle hardness measurement by using ultrasound elastography: a feasibility study. Acta Radiol 2011, 52:99-105.
• [19]Ariji Y, Katsumata A, Hiraiwa Y, Izumi M, Iida Y, Goto M, et al.: Use of sonographic elastography of the masseter muscle for optimizing massage pressure: a preliminary study. J Oral Rehab 2009, 36:627-35.
• [20]Gershuni DH, Gosink BB, Hargens AR, Gould RN, Forsythe JR, Mubarak SJ: Ultrasound Evaluation of the anterior musculofascial compartment of the leg following exercise. Clin Orthop Rel Res 1982, 167:185-190.
• [21]Rajasekaran S, Beavis C, Aly AR, Leswick D: The utility of ultrasound in detecting anterior compartment thickness changes in chronic exertional compartment syndrome: a pilot study. Clin J Sport Med 2013, 23:305-11.
• [22]Shuler FD, Dietz MJ: Physicians’ ability to manually detect isolated elevations in leg intracompartmental Pressure. J Bone Joint Surg Am 2010, 92:361-7.
• [23]Heckman MM, Whiteside TE Jr, Grewe SR, Judd RL, Miller M, Lawrence JH 3rd: Histologic determination of the ischemic threshold of muscle in the canine compartment syndrome model. J Orthop Trauma 1993, 7:199-210.
• [24]Matava MJ, Whiteside TE Jr, Seiler JG 3rd, Hewan-Lowe K, Hutton WC: Determination of the compartment pressure threshold of muscle ischemia in a canine model. J Trauma 1994, 37:50-58.
• [25]Heckman MM, Whiteside TE, Grewe SR, Rooks MD: Compartment pressure in association with closed tibial fractures: the relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Joint Surg Am 1994, 76-A:1285-92.
• [26]Tiwari A, Haq AI, Myint F, Hamilton G: Acute compartment syndromes. Br J Surg 2002, 89:397-412.
• [27]Tzioupis C, Cox G, Giannoudis PV: Acute compartment syndrome of the lower extremity: an update. Orthopaedics Trauma 2009, 23:433-440.
• [28]Murayama M, Nosaka K, Yoneda T, Minamitani K: Changes in hardness of the human elbow flexor muscle after eccentric exercise. Europ J Appl Physiol 2000, 82:361-367.
• [29]Ulmer T: The clinical diagnosis of compartment syndrome of the lower leg are clinical findings predictive of the disorder? J Orthop Trauma 2002, 16:572-7.