gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

23.10. - 26.10.2018, Berlin

Ultrasound measurement in the diagnosis of lower leg compartment syndrome – a pilot study

Meeting Abstract

  • presenting/speaker Jakob Mühlbacher - Medical University Vienna, Department of Surgery, Division of General Surgery, Vienna, Austria
  • Reinhard Pauzenberger - Medical University Vienna, Department of Surgery, Division of Plastic Surgery, Vienna, Austria
  • Ulrika Asenbaum - Medical University Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
  • Tobias Gauster - University of Natural Resources and Life Sciences, Institute of Applied Statistics and Computing, Vienna, Austria
  • Stephan Kapral - Department of Anaesthesiology and Intensive Care, Linz, Austria
  • Andreas Duma - Medical University Vienna, Department of Anaesthesiology and General Intensive Care, Vienna, Austria

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocPT24-467

doi: 10.3205/18dkou779, urn:nbn:de:0183-18dkou7794

Veröffentlicht: 6. November 2018

© 2018 Mühlbacher et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Early diagnosis of acute lower leg compartment syndrome is essential to improve outcome. Currently, direct invasive measurement is the recommended method for measurement of intramuscular pressure, despite its limitations. The purpose of this pilot study was to investigate the feasibility of ultrasound-guided angle measurement between the tibia bone and the muscle fascia (tibia-fascia-angle, TFA) as a non-invasive surrogate of increased pressure in the ventral compartment of the lower leg.

Methods: Acute compartment syndrome was generated by infusion of saline in the ventral compartment of the lower leg of human cadavers to incrementally increase the intracompartmental pressure from 10 to 100 mmHg. In 40 legs (20 cadavers) the angle between the rigid lateral face of the tibia bone and the expansive fascia of the anterior compartment was measured at each 10 mmHg pressure increase using ultrasound in a standardized transversal plane. Using linear regression, invasively measured pressure levels were correlated with tibia-fascia-angles (TFA). Furthermore TFA of right and left leg were compared.

Results and conclusion: Measured TFA [mean (± SD)] enlarged from 61.0 (± 12.0) degrees at 10 mmHg up to 81.1 (± 11.1) respectively at 100 mmHg compartment pressure. TFA and pressure were strongly correlated (mean R2: 0.95; range: 0.85 - 0.99; n = 40). Comparing legs in each individual at 10 mmHg revealed significant equivalent results (mean differences -2.31, 95% CI -4.3 to -0.36, p = 0.014) and a low probability of 7% for a TFA difference between the left and tight lower leg compartment of more than 10 degrees. There was a strong positive correlation between TFA and compartment pressure in the lower leg in each cadaver. A left-to-right TFA difference above 10 degrees may indicate unilateral compartment syndrome. Ultrasound guided measurement of TFA may be a feasible non-invasive alternative or addition to invasive measurements for diagnosis of acute compartment syndrome of the lower leg.