NL: Correlation Between Muscle Oxygenation and Compartment Pressures in Acute Compartment Syndrome of the Leg

http://www.ejbjs.org/cgi/content/abstract/92/4/863

The Journal of Bone and Joint Surgery (American). 2010;92:863-870.
doi:10.2106/JBJS.I.00816
© 2010 The Journal of Bone and Joint Surgery, Inc.

Michael S. Shuler, MD¹, William M. Reisman, MD², Tracy L. Kinsey, MSPH¹, Thomas E. Whitesides, Jr., MD³, E. Mark Hammerberg, MD⁴, Maria G. Davila, MD⁵ and Thomas J. Moore, MD⁵

¹ Athens Orthopedic Clinic, 1765 Old West Broad Street, Suite 200, Athens, GA 30606. E-mail address for M.S. Shuler: msimmss@hotmail.com
² 59 Executive Park South, 2nd Floor, Atlanta, GA 30329
³ 958 Calvert Lane N.E., Atlanta, GA 30319
⁴ 1550 Professional Lane, Suite 200, Longmont, CO 80501
⁵ 49 Jesse Hill Jr. Drive, Suites 313 (M.G.D.) and 307 (T.J.M.), Atlanta, GA 30303
Investigation performed at Grady Memorial Hospital, Atlanta, and Emory University, Atlanta, Georgia
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Somanetics and Stryker (in the form of product donations). In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Somanetics).

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Background Near-infrared spectroscopy estimates soft-tissue oxygenation approximately 2 to 3 cm below the skin. The purpose of the present study was to evaluate muscle oxygenation in the setting of an acute compartment syndrome of the leg and to determine if near-infrared spectroscopy is capable of detecting perfusion deficits.

Methods Fourteen patients with unilateral lower extremity trauma were enrolled after the diagnosis of an acute compartment syndrome was made clinically and confirmed with intracompartmental pressure measurements. Lower extremity muscle compartments were evaluated with near-infrared spectroscopy, and near-infrared spectroscopy values of the uninjured, contralateral leg of each patient were used as internal reference values. The compartment perfusion gradient was calculated as the diastolic blood pressure minus the intracompartmental pressure.
Results Intracompartmental pressures ranged from 21 to 176 mm Hg (mean, 79 mm Hg) and exceeded 30 mm Hg in all compartments but two (both in the same patient). Thirty-eight compartments had a perfusion gradient of 10 mm Hg (indicating ischemia). Among ischemic compartments, near-infrared spectroscopy values in the anterior, lateral, deep posterior, and superficial posterior compartments of the injured limbs were decreased by an average 10.1%, 10.1%, 9.4%, and 16.3% in comparison with the corresponding compartments of the uninjured leg. Differences in near-infrared spectroscopy values (the near-infrared spectroscopy value for the injured leg minus the near-infrared spectroscopy value for the uninjured leg) were positively correlated with compartment perfusion gradient within each compartment (r = 0.82, 0.65, 0.67, and 0.62, for the anterior, lateral, deep posterior, and superficial posterior compartments, respectively; p < 0.05 for all).
Conclusions Normalized near-infrared spectroscopy values decrease significantly with decreasing lower limb perfusion pressures. Near-infrared spectroscopy may be capable of differentiating between injured patients with and without an acute compartment syndrome.
Level of Evidence Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.