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Diagnostik und Therapieentscheidung beim akuten Kompartmentsyndrom

Ergebnisse einer Umfrage in deutschen Kliniken

Diagnostics and treatment decisions in acute compartment syndrome

Results of a survey in German hospitals

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Zusammenfassung

Hintergrund und Fragestellung

In der vorgelegten Umfrage sollte untersucht werden, ob aktuell eine Vereinheitlichung von Diagnostik und Therapie hinsichtlich des akuten Kompartmentsyndroms zu beobachten ist.

Material und Methoden

Eingeschlossen wurden Universitätskliniken, akademische Lehrkrankenhäuser und Kreiskliniken im gesamten Bundesgebiet.

Ergebnisse

Es nahmen 38 % der 316 angeschriebenen Kliniken teil. Die Mehrzahl der Teilnehmer war im Status eines Facharztes (68 %). Insgesamt wurde die Wertigkeit der klinischen Untersuchung besser eingeschätzt als die der apparativen Diagnostik. Bei Verwendung apparativer Diagnostik wurde insbesondere die intramuskuläre Druckmessung verwendet. Die Hälfte der Befragten gab an, die Indikation zur operativen Fasziotomie anhand der klinischen Situation und der Druckmessung zu stellen. Der Ort der Druckmessung, der Grenzwert für die Indikation zur Fasziotomie sowie die zur Anwendung kommende Technik divergierten zwischen den teilnehmenden Kliniken.

Diskussion

Die Diskussion bezüglich der Diagnosestellung und der Indikationsstellung zur operativen Therapie scheint weiterhin nicht abgeschlossen. Die Etablierung einheitlicher Behandlungsrichtlinien könnte dazu beitragen, die Anzahl der verzögert diagnostizierten Kompartmentsyndrome zu reduzieren.

Abstract

Background and objectives

The presented survey was intended to evaluate whether a standardization of diagnostics and therapy for acute compartment syndrome has been achieved.

Materials and methods

University hospitals, academic teaching hospitals, and county hospitals in Germany were included.

Results

A total of 38% (n=120) of all contacted hospitals participated in this study with questions mainly answered by consulting physicians (68%). In general the importance of the clinical examination was considered as being more important than other diagnostic measures. In cases where further diagnostics were necessary, the intramuscular pressure measurement was used most frequently. Of the participants 50% performed surgical fasciotomy based on the clinical examination in combination with the intramuscular pressure measurement; however, there were considerable differences between the participating hospitals with respect to the anatomical position of intramuscular measurements, the limiting value of the intramuscular pressure and the surgical technique for performing fasciotomy.

Conclusion

According to the presented analysis the diagnosis and indications for surgical treatment in patients developing an acute compartment syndrome do not seem to be sufficiently clarified. The establishment of unified treatment guidelines could help to reduce the number of delayed diagnoses of compartment syndrome.

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Literatur

  1. Al-Dadah OQ, Darrah C, Cooper A et al (2008) Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures. Injury 39:1204–1209

    Article  CAS  PubMed  Google Scholar 

  2. Cascio BM, Wilckens JH, Ain MC et al (2005) Documentation of acute compartment syndrome at an academic health-care center. J Bone Joint Surg Am 87:346–350

    Article  PubMed  Google Scholar 

  3. Finkelstein JA, Hunter GA, Hu RW (1996) Lower limb compartment syndrome: course after delayed fasciotomy. J Trauma 40:342–344

    Article  CAS  PubMed  Google Scholar 

  4. Fitzgerald AM, Gaston P, Wilson Y et al (2000) Long-term sequelae of fasciotomy wounds. Br J Plast Surg 53:690–693

    Article  CAS  PubMed  Google Scholar 

  5. Frink M, Hildebrand F, Krettek C et al (2010) Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res 468:940–950

    Article  PubMed Central  PubMed  Google Scholar 

  6. Frink M, Klaus AK, Kuther G et al (2007) Long term results of compartment syndrome of the lower limb in polytraumatised patients. Injury 38:607–613

    Article  PubMed  Google Scholar 

  7. Garner AJ, Handa A (2010) Screening tools in the diagnosis of acute compartment syndrome. Angiology 61:475–481

    Article  PubMed  Google Scholar 

  8. Harris IA, Kadir A, Donald G (2006) Continuous compartment pressure monitoring for tibia fractures: does it influence outcome? J Trauma 60:1330–1335

    Article  PubMed  Google Scholar 

  9. Heckman MM, Whitesides TE Jr, Grewe SR et al (1994) 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 76:1285–1292

    CAS  Google Scholar 

  10. Heemskerk J, Kitslaar P (2003) Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies. World J Surg 27:744–747

    Article  PubMed  Google Scholar 

  11. Heppenstall RB, Sapega AA, Izant T et al (1989) Compartment syndrome: a quantitative study of high-energy phosphorus compounds using 31P-magnetic resonance spectroscopy. J Trauma 29:1113–1119

    Article  CAS  PubMed  Google Scholar 

  12. Kosir R, Moore FA, Selby JH et al (2007) Acute lower extremity compartment syndrome (ALECS) screening protocol in critically ill trauma patients. J Trauma 63:268–275

    Article  PubMed  Google Scholar 

  13. Mcqueen MM, Christie J, Court-Brown CM (1996) Acute compartment syndrome in tibial diaphyseal fractures. J Bone Joint Surg Br 78:95–98

    CAS  PubMed  Google Scholar 

  14. Mcqueen MM, Court-Brown CM (1996) Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 78:99–104

    CAS  PubMed  Google Scholar 

  15. Olson SA, Glasgow RR (2005) Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg 13:436–444

    PubMed  Google Scholar 

  16. Phillips JH, Mackinnon SE, Beatty SE et al (1987) Vibratory sensory testing in acute compartment syndromes: a clinical and experimental study. Plast Reconstr Surg 79:796–801

    Article  CAS  PubMed  Google Scholar 

  17. Present DA, Nainzedeh NK, Ben-Yishay A et al (1993) The evaluation of compartmental syndromes using somatosensory evoked potentials in monkeys. Clin Orthop Relat Res 287:276–285

    PubMed  Google Scholar 

  18. Shadgan B, Menon M, O’brien PJ et al (2008) Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma 22:581–587

    Article  PubMed  Google Scholar 

  19. Shadgan B, Menon M, Sanders D et al (2010) Current thinking about acute compartment syndrome of the lower extremity. Can J Surg 53:329–334

    PubMed Central  PubMed  Google Scholar 

  20. Sheridan GW, Matsen FA III (1976) Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am 58:112–115

    CAS  PubMed  Google Scholar 

  21. Shuler MS, Reisman WM, Kinsey TL et al (2010) Correlation between muscle oxygenation and compartment pressures in acute compartment syndrome of the leg. J Bone Joint Surg Am 92:863–870

    Article  PubMed  Google Scholar 

  22. Sterk J, Schierlinger M, Gerngross H et al (2001) Intracompartmental pressure measurement in in acute compartment syndrome. Results of a survey of indications, measuring technique and critical pressure value. Unfallchirurg 104:119–126

    Article  CAS  PubMed  Google Scholar 

  23. Tiwari A, Haq AI, Myint F et al (2002) Acute compartment syndromes. Br J Surg 89:397–412

    Article  CAS  PubMed  Google Scholar 

  24. Ulmer T (2002) The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma 16:572–577

    Article  Google Scholar 

  25. Vollmar B, Westermann S, Menger MD (1999) Microvascular response to compartment syndrome-like external pressure elevation: an in vivo fluorescence microscopic study in the hamster striated muscle. J Trauma 46:91–96

    Article  CAS  PubMed  Google Scholar 

  26. Wall CJ, Lynch J, Harris IA et al (2010) Clinical practice guidelines for the management of acute limb compartment syndrome following trauma. ANZ J Surg 80:151–156

    Article  PubMed  Google Scholar 

  27. White TO, Howell GE, Will EM et al (2003) Elevated intramuscular compartment pressures do not influence outcome after tibial fracture. J Trauma 55:1133–1138

    Article  PubMed  Google Scholar 

  28. Williams PR, Russell ID, Mintowt-Czyz WJ (1998) Compartment pressure monitoring – current UK orthopaedic practice. Injury 29:229–232

    Article  CAS  PubMed  Google Scholar 

  29. Willy C, Sterk J, Volker HU et al (2001) Acute compartment syndrome. Results of a clinico-experimental study of pressure and time limits for emergency fasciotomy. Unfallchirurg 104:381–391

    Article  CAS  PubMed  Google Scholar 

  30. Willy C, Volker HU, Weber F et al (1998) Reduced muscular oxygen tension and nerve impulse transmission from antishock hose. Reduction of oxygen tension in the tibial muscle and impulse transmission in the peroneal nerve from pneumatic − 1 pressure from antishock hose. Anaesthesist 47:571–580

    Article  CAS  PubMed  Google Scholar 

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Einhaltung ethische Richtlinien

Interessenskonflikt: R.M. Sellei, H. Andruszkow, C. Weber, T.O. Damen, H.-C. Pape und F. Hildebrand geben an, dass kein Interessenskonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädische Chirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland

    R.M. Sellei

  2. Klinik für Unfall- und Wiederherstellungschirurgie , Universitätsklinikum Aachen, Aachen, Deutschland

    R.M. Sellei, H. Andruszkow, C. Weber, T.O. Damen, H.-C. Pape & F. Hildebrand

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  1. R.M. Sellei
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  2. H. Andruszkow
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  3. C. Weber
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  4. T.O. Damen
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  5. H.-C. Pape
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  6. F. Hildebrand
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Correspondence to R.M. Sellei.

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Sellei, R., Andruszkow, H., Weber, C. et al. Diagnostik und Therapieentscheidung beim akuten Kompartmentsyndrom. Unfallchirurg 119, 125–132 (2016). https://doi.org/10.1007/s00113-014-2609-0

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  • DOI: https://doi.org/10.1007/s00113-014-2609-0

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