Advertisement

Compartment pressures in children with normal and fractured lower extremities

  • Hannah Rachel BussellEmail author
  • Christoph Alexander Aufdenblatten
  • Ulrike Subotic
  • Markus Kalisch
  • Georg Staubli
  • Daniel Max Weber
  • Sasha Sasha Tharakan
Original Article
  • 31 Downloads

Abstract

Purpose

Needle manometry is a tool to confirm suspected acute compartment syndrome (ACS). There is scarce evidence of normal pressure values of the lower extremities in children. The aim of this study is to assess the normal compartment pressures in non-injured lower extremities of children.

Methods

This prospective study included children up to the age of 16 years with lower extremity fractures that needed reduction. Between June 2009 and August 2015, 20 children were included. We used needle manometry to measure the pressures in the superficial (SPC), deep posterior (DPC) and in the anterior compartments (AC) on both the lower legs.

Results

On the healthy leg, the mean compartment pressure was 15.15 mmHg in the AC (range 7–30 mmHg), 14.32 mmHg in the SPC (range 8–24 mmHg) and 13.00 mmHg in the DPC (range 4–21 mmHg). On the injured leg, the mean compartment pressure was 24.07 mmHg in the AC (range 5–40 mmHg), 17.21 mmHg in the SPC (range 7–29 mmHg) and 17.13 mmHg in the DPC (range 6–37 mmHg). We found a perfusion gradient (diastolic blood pressure—compartment pressure) < 30 mmHg in at least one compartment of the fractured and healthy leg in 13 patients. Five patients underwent fasciotomy for suspected ACS and their data was excluded for the injured leg.

Conclusion

We could show that children have higher normal compartment pressures than adults in the lower leg. They seem to be able to tolerate higher absolute compartment pressures and lower pressure gradients before ACS occurs. More studies are needed to make a final statement on tolerable compartment pressures in children.

Keywords

Compartment pressure Pediatric Compartment syndrome Lower extremity 

Notes

Funding

The authors hereby confirm that no funding was received for this project.

Compliance with ethical standards

Conflict of interest

The authors hereby confirm that no conflicts of interest exist.

Ethical approval

The project was approved by our local Ethics Committee.

References

  1. 1.
    Seddon HJ. Volkmann’s contracture: treatment by excision of the infarct. J Bone Joint Surg Br. 1956;38-B(1):152–74.CrossRefPubMedGoogle Scholar
  2. 2.
    Volkmann RV. The Classic: ischaemic muscle paralyses and contractures. Clin Orthop Relat Res. 2007;456:20–1.  https://doi.org/10.1097/BLO.0b013e318032561f.CrossRefGoogle Scholar
  3. 3.
    Bae DS, Kadiyala RK, Waters PM. Acute compartment syndrome in children: contemporary diagnosis, treatment, and outcome. J Pediatr Orthop. 2001;21(5):680–8.PubMedGoogle Scholar
  4. 4.
    Broom A, Schur MD, Arkader A, et al. Compartment syndrome in infants and toddlers. J Child Orthop. 2016;10(5):453–60.  https://doi.org/10.1007/s11832-016-0766-0.CrossRefPubMedGoogle Scholar
  5. 5.
    Whitesides TE, Haney TC, Morimoto K, et al. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975;113:43–51.CrossRefGoogle Scholar
  6. 6.
    Matsen FAF, Winquist RAR, Krugmire RBR. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. 1980;62(2):286–91.CrossRefPubMedGoogle Scholar
  7. 7.
    Cohen MS, Garfin SR, Hargens AR, et al. Acute compartment syndrome. Effect of dermotomy on fascial decompression in the leg. J Bone Joint Surg Br. 1991;73(2):287–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Staudt JM, Smeulders MJC, van der Horst CMAM. Normal compartment pressures of the lower leg in children. J Bone Joint Surg Br. 2008;90(2):215–9.  https://doi.org/10.1302/0301-620X.90B2.19678.CrossRefPubMedGoogle Scholar
  9. 9.
    Tharakan SJ, Subotic U, Kalisch M, et al. Compartment pressures in children with normal and fractured forearms: a preliminary report. J Pediatr Orthop.  https://doi.org/10.1097/BPO.0000000000000471.
  10. 10.
    Hargens AR, Ballard RE. Basic principles for measurement of intramuscular pressure. Oper Tech Sports Med. 1995;3(4):237–42.CrossRefPubMedGoogle Scholar
  11. 11.
    Boody AR. Accuracy in the measurement of compartment pressures: a comparison of three commonly used devices. J Bone Joint Surg Am. 2005;87(11):2415.  https://doi.org/10.2106/JBJS.D.02826.PubMedGoogle Scholar
  12. 12.
    Van Buuren S. Flexible imputation of missing data. CRC Press, Boca Raton, 2012.CrossRefGoogle Scholar
  13. 13.
    Gershuni DH, Yaru NC, Hargens AR, et al. Ankle and knee position as a factor modifying intracompartmental pressure in the human leg. J Bone Joint Surg Am. 1984;66(9):1415–20.CrossRefPubMedGoogle Scholar
  14. 14.
    Whitesides T, Heckman M. Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg. 1996;4(4):209–18.CrossRefPubMedGoogle Scholar
  15. 15.
    Matava MJ, Whitesides TE, Seiler JG, et al. Determination of the compartment pressure threshold of muscle ischemia in a canine model. J Trauma Injury Infect Crit Care. 1994;37(1):50–8.CrossRefGoogle Scholar
  16. 16.
    Dahn I, Lassen NA, Westling H. Blood flow in human muscles during external pressure or venous stasis. Clin Sci. 1967;32(3):467–73.PubMedGoogle Scholar
  17. 17.
    Heckman MM, Whitesides TE, Grewe SR, et al. Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture. J Bone Joint Surg Am. 1994;76(9):1285–92.CrossRefPubMedGoogle Scholar
  18. 18.
    Shuler MS, Roskosky M, Kinsey T, et al, 2018. Continual near-infrared spectroscopy monitoring in the injured lower limb and acute compartment syndrome: an FDA-IDE trial. Bone Joint J.  https://doi.org/10.1302/0301-620X.100B6.PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric Surgery, General and Thoracic SurgeryUniversity Children’s Hospital ZurichZurichSwitzerland
  2. 2.Trauma and Orthopaedic SurgeryUniversity Children’s Hospital ZurichZurichSwitzerland
  3. 3.Seminar for StatisticsETH ZurichZurichSwitzerland
  4. 4.Department of Emergency MedicineUniversity Children’s Hospital ZurichZurichSwitzerland
  5. 5.Pediatric Hand SurgeryUniversity Children’s Hospital ZurichZurichSwitzerland

Personalised recommendations