Palpae Madura — a Novel Non-invasive Method for Detecting Impending Compartment Syndrome in Trauma

Abstract

Background

Compartment syndrome is one of the surgical emergencies in which prompt treatment can save a patient’s life. Many trauma centres currently detect compartment syndrome based on clinical suspicion, whereas experts have advocated for routine monitoring of compartment pressure to reduce the number of unnecessary fasciotomies. Newer electronic devices for measuring compartment pressure are invasive and expensive; their availability factors limit their use. Our research presents a unique non-invasive method for detecting impending compartment syndrome that may be used in any trauma centre or peripheral centre, allowing intervention at an earlier stage.

Materials and Methods

A total of one hundred fifty-three patients with a closed forearm and leg fractures were enrolled in the study. Patients with pre-existing heart illness, peripheral vascular disease, open fractures, and bilateral injuries were excluded. Both Whiteside needle manometry and our novel approach were used to assess the compartment status of the limb by two separate investigators who were double-blinded. Compartment pressure was measured in every compartment in the limb, and the compartment with the highest pressure was taken into consideration. Clinical and manometry values were used to guide fasciotomy.

Results and Discussion

Out of one hundred fifty-three patients, forty-eight (31%) underwent fasciotomy based on clinical and manometry criteria. On analysis of the newer technique with Whiteside manometry, a positive correlation with a Pearson coefficient of + 0.92 and a p-value (< 0.05) was seen. Our proposed technique could not be used in regions other than the forearm and leg and on patients where distal pulse could not be felt. The newly proposed technique provides a simple non-invasive method for classifying and intervening in patients with impending compartment syndrome.