Compartment elasticity measured by pressure-related ultrasound to determine patients -at risk- for compartment syndrome: an experimental in vitro studyReport as inadecuate




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Patient Safety in Surgery

, 9:4

First Online: 24 January 2015Received: 30 October 2014Accepted: 17 December 2014

Abstract

BackgroundDecision-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.

MethodsIn 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.

ResultsWith 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 r = −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.

ConclusionsOur 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.

KeywordsCompartment syndrome Intra-compartmental pressure Non-invasive diagnostic Elasticity measurement Elastography Electronic supplementary materialThe online version of this article doi:10.1186-s13037-014-0051-4 contains supplementary material, which is available to authorized users.

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Author: Richard Martin Sellei - Simon Johannes Hingmann - Philipp Kobbe - Christian Weber - John Edward Grice - Frauke Zimmerman

Source: https://link.springer.com/article/10.1186/s13037-014-0051-4







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