Fri., 10/14/11 Tibia, Paper #49, 11:14 am OTA-2011
Δ •Measurement of Tissue Oxygenation as a Novel Approach to Diagnosis of Compartment Syndrome
Erik H. Hansen, MD1; James M. Mok, MD2; Givenchy Manzano, BS1; Utku Kandemir, MD1;
1Dept. of Orthopaedic Surgery, University of California San Francisco,
San Francisco, California, USA;
2Orthopaedic Surgery Service, Dept. of Surgery, Madigan Army Medical Center,
Tacoma, Washington, USA
Purpose: The goal of treatment in compartment syndrome is to avoid irreversible muscle and nerve tissue damage. Acute compartment syndrome remains challenging due to diagnostic difficulty. The purpose of this study is to investigate the feasibility of continuous measurement of intramuscular tissue oxygenation (PmO2) of the leg, its sensitivity to tourniquet ischemia, and to compare the predetermined warning criteria for compartment syndrome based on compartment pressure (CP) and PmO2 after tibia fracture.
Methods: The control arm consisted of patients undergoing ankle fracture fixation with tourniquet (n = 5). In the observational arm, patients undergoing intramedullary nailing for closed tibia fracture received continuous measurement of PmO2 and CP of the anterior compartment for 48 hours postoperatively (n = 11). The number of measurements meeting the tissue oxygenation warning criterion (PmO2 <10 mm Hg) was compared to the number of measurements meeting warning criteria for CP (CP >30 mm Hg, delta P (DBP–CP) <30 mm Hg).
Results: In the control group, mean PmO2 was 26.75 mm Hg and decreased rapidly after tourniquet application to 0.52 mm Hg (range, 0.1-1.4). In the experimental group, mean CP was 27.2 mm Hg and mean PmO2 was 27.7 mm Hg. No patient developed compartment syndrome. All 11 patients had CP greater than 30 mm Hg (mean, 46% of measurements; range, 3.8%-100%). For delta P <30 mm Hg, 8 patients met warning criteria (mean, 31%; range, 0-98%). Only 2 patients had PmO2 <10 for 178 minutes and 167 minutes respectively. PmO2 tended to show less variability than CP (18% vs 25%; P = 0.09).
Conclusion: Our data establish the feasibility of measuring continuous tissue oxygenation and its responsiveness to ischemia. CP measurements met warning criteria more often than PmO2 in the absence of compartment syndrome. PmO2 <10 mm Hg may represent a clinically important threshold. Measurement of direct tissue oxygenation can be considered as physiologic and a more specific method for diagnosing compartment syndrome as an indicator of muscle tissue viability.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.