In this work, we propose a new quantitative way of evaluating acute compartment syndrome (ACS) by dynamic mechanical assessment of soft tissue changes. First, we have developed an animal model of ACS to replicate the physiological changes during the condition. Secondly, we have developed a mechanical assessment tool for quantitative pre-clinical assessment of ACS. Our hand-held indentation device provides an accurate method for investigations into the local dynamic mechanical properties of soft tissue and for in-situ non-invasive assessment and monitoring of ACS. Our compartment syndrome model was developed on the cranial tibial and the peroneus tertius muscles of a pig's leg (postmortem). The compartment syndrome pressure values were obtained by injecting blood from the bone through the muscle. To enable ACS assessment by a hand-held indentation device we combined three main components: a load cell, a linear actuator and a 3-axis accelerometer. Dynamic tests were performed at a frequency of 0.5 Hz and by applying an amplitude of 0.5 mm. Another method used to observe the differences in the mechanical properties inside the leg was a 3D Digital Image Correlation (3D-DIC). Videos were taken from two different positions of the pig's leg at different pressure values: 0 mmHg, 15 mmHg and 40 mmHg. Two strains along the x axis (Exx) and y axis (Eyy) were measured. Between the two pressure cases (15 mmHg and 40 mmHg) a clear deformation of the model is visible. In fact, the bigger the pressure, the more visible the increase in strain is. In our animal model, local muscle pressures reached values higher than 40 mmHg, which correlate with observed human physiology in ACS. In our presentation we will share our dynamic indentation results on this model to demonstrate the sensitivity of our measurement techniques. Compartment syndrome is recognised as needing improved clinical management tools. Our approach provides both a model that reflects physiological behaviour of ACS, and a method for in-situ non-invasive assessment and monitoring

Introduction. Compartment syndrome can be a life changing consequence of injury to a limb. If not diagnosed and treated early it can lead to permanent disability. Neurovascular observations done on the ward by nursing staff, are often our early warning system to those developing compartment syndrome. But are these adequate for detecting the early signs of compartment syndrome? Our aim was to compare the quality and variability of charts across the UK major trauma network. Materials & Methods. All major trauma centres in England and Scotland were invited to supply a copy of the neurovascular chart routinely used. We assessed how such charts record relevant information. Specific primary data points included were pain scores, analgesia requirements, pain on passive stretch and decreased sensation in the first web space specifically. As secondary objectives, we assessed how late signs were recorded, whether clear instructions were included, quantitative scores and the use of regional blocks recorded. Results. A response rate of 46% was achieved. Of the charts reviewed, 25% documented pain scores or pain on passive movement. Pain on movement and analgesia requirements were documented in 33% and 8% respectively. Specific sensation within the 1. st. webspace was recorded in 16%. No charts recorded use of regional block. All charts recorded global sensation, movement (unspecified), pulse and colour whilst 66% documented capillary refill and 83% temperature. Instructions were included in 41% of charts. Conclusions. In 2016, the BOA supported publication of an observation chart for this purpose however, it is not widely used. In our study, late signs of compartment syndrome were generally well recorded. However, documentation of early signs and regional blocks was poor. This may lead to delays in diagnosis with significant clinical and medicolegal consequences. Standardisation of documentation by updating and promoting the use of the pre-existing chart would ensure highest quality care across the network

Purpose of the study: We noted that four postoperative compartment syndromes observed in our department occurred in short stature patients with micromely secondary to chondrodysplasia. This complication occurred in young subjects with significant muscular development (two with intensive sports practice) whose muscle hypertrophy appeared exaggerated by the short length of the limbs. Material and methods: The first case concerned a young man with pycnodysostosis who developed a tibial compartment syndrome after prolonged ventral decubitus subsequent to spinal surgery. No surgical procedure had been performed on the lower limb. The complication was probably triggered by simple compression of the proximal portion of the limb leading to elevated venous pressure and rapid self-aggravating muscular atrophy in a small aponeurotic compartment. The second case was a female patient with metaphyseal dysplasia who during adolescence had undergone corrective bilateral tibial osteotomy to align the lower limbs. Preventive aponeurotomy had been performed which left on one side a disgraceful muscle herniation. Aponeurotic plasty had been performed in adulthood to reconstitute the tibial compartment. A compartment syndrome developed in the immediate postoperative period. The third case was a young adult with hypochondroplasia who developed bilateral crural compartment syndrome 24 hours after femoral osteotomy with implantation of an external fixator for lower limb lengthening. Results: Sequelae were observed in only one of these four cases of compartment syndrome (patient n° 1). Extensive necrosis of the tibialis anterior was observed due to late diagnosis, leading to legal implications and a court suit. Emergency treatment was given in the three other cases and no sequelae were observed. Discussion: These patients with chondrodysplasia and micromely appeared to be predisposed to postoperative compartment syndrome because of the relative muscle hypertrophy and the narrow muscle compartments. The risk of this complication in small stature patients warrants the use of preventive aponeurotomy during orthopedic procedures involving the limbs and implies rigorous postoperative surveillance for early detection. Systematic aponeurotomies should be extended over the entire length of the muscle compartment involved in order to achieve effective decompression and avoid disgraceful localized muscle herniation

Purpose: Compartment syndrome is a limb-threatening condition. Treatment is urgent decompression by fas-ciotomy. However, orthopedic surgeons are often confronted by a limb at risk for compartment syndrome, in which treatments to preserve tissue might be considered. Hypothermia has shown promise as a technique of maintaining tissue viability in transplant surgery, replant surgery and soft tissue injury. Cooling reduces microvascular dysfunction, inflammation and edema. This study was designed to determine whether tissue cooling might reduce muscle damage in the setting of elevated intracompartmental pressure. Purpose This study investigated the effect of hypothermia on tissue perfusion, viability and the inflammatory response in an animal model of elevated intracompartmental pressure. We hypothesize that hypothermia will preserve muscle tissue viability in an animal model of elevated intracom-partmental pressure. Method: Twenty Wistar rats were randomized. Five animals had elevated intracompartmental pressure for 2 hours (CS). Five had elevated pressure and hindlimb cooling to 25oC (CS-HY). Five had hindlimb cooling to 25oC (HY) and 5 were control animals (C). All animals were anaesthesized for study. Core temperature was maintained over 30oC. Elevated ICP was maintained (30mmHg) using a saline infusion technique (groups CS and CS-HY). After 2 hours, fasciotomies were completed and intravital microscopy was used to measure tissue viability, microvascular perfusion and inflammation. Results: The use of hypothermia reduced tissue damage by approximately 50% in the CS-HY group (8.2% injured cells) compared with the CS group (16.5% injured cells). There was no difference in capillary perfusion comparing the CS and CS-HY groups (p> 0.05). The number of adherent inflammatory cells was fewer comparing the CS-HY with the CS groups, but this did not reach statistical significance with the numbers available for study. Conclusion: Hypothermia preserved tissue viability in an animal model of elevated intracompartmental pressure. Fasciotomy remains the gold standard treatment for established compartment syndrome. However cooling may be useful to preserve tissue viability in extremities that are at risk of developing compartment syndrome. The clinical utility of hypothermia for compartment syndrome requires further study

Acute Compartment Syndrome (ACS) is an orthopaedic emergency that can develop after a wide array of etiologies. In this pilot study the MY01 device was used to assess its ease of use and its ability to continuously reflect the intracompartmental pressure (ICP) and transmit this data to a mobile device in real time. This preliminary data is from the lead site which is presently expanding data collection to five other sites as part of a multi-center study. Patients with long bone trauma of the lower or upper extremity posing a possibility of developing compartment syndrome were enrolled in the study. Informed consent was obtained from the patients. A Health Canada licensed continuous compartmental pressure monitor (MY01) was used to measure ICP. The device was inserted in the compartment that was deemed most likely to develop ACS and ICP was continuously measured for up to 18 hours. Fractures were classified according to the AO/OTA classification. Patient clinical signs and pain levels were recorded by healthcare staff during routine in-patient monitoring and were compared to the ICP from the device. Important treatment information was pulled from the patient's chart to help correlate all of the patient's data and symptoms. The study period was conducted from November 2020 through December 2021. Twenty-six patients were enrolled. There were 17 males, and nine females. The mean age was 38 years (range, 17–76). Seventeen patients received the device post-operatively and nine received it pre-operatively. Preliminary results show that post-operative ICPs tend to be significantly higher than pre-operative ICPs but tend to trend downwards very quickly. The trend in this measurement appears to be more significant than absolute numbers which is a real change from the previous literature. One patient pre-operatively illustrated a steep trend upwards with minimal clinical symptoms but required compartment release at the time of surgery that exhibited no muscle necrosis. The trend in this patient was very steep and, as predicted, predated the clinical findings of compartment syndrome. This trend allows an early warning signal of the absolute pressure, to come, in the compartment that is being assessed by the device. Preliminary results suggest that this device is reliable and relatively easy to use within our institutions. In addition it suggests that intracompartmental pressures can be higher immediately post-op but lower rapidly when the patient does not develop ACS. These results are in line with current literature of the difference between pre and post-operative baselines and thresholds of ICP, but are much more striking, as continuous measurements have not been part of the data set in most of past studies. Further elucidation of the pressure thresholds and profiles are currently being studied in the ongoing larger multicenter study and will add to our understanding of the critical values. This data, plus the added value of continuous trends in the pressure, upwards or downwards, will aid in preventing muscle necrosis during our management of these difficult long bone fractures

Purpose: Since the advent of pinning for supracondylar fractures of the humerus, Volkmann syndrome has been exceptional and most of the posttraumatic compartment syndromes observed in children have been seen in the lower limb. We propose an analysis of the causes, the diagnosis, the treatment and the results of treatment of acute posttraumatic compartment syndrome of the leg in children. Material and methods: Twenty-eight consecutive cases of acute posttraumatic compartment syndrome in 27 children were reviewed. These children were treated in two American paediatric traumatology units over a ten year period. We evaluated the cause of the trauma, associated lesions, clinical course, diagnostic methods, muscle compartment pressures, time from accident to diagnosis, and time from accident to surgery. Results were analysed at last follow-up. Results: The study population was 24 boys and three girls, aged 4 months to 15 years. Twenty-four children were pedestrian traffic accident victims. Twenty-two had a tibial fracture, four a femoral fracture, and two no fracture. Twenty-five compartment syndromes were diagnosed on the basis of compartment pressure measurements. Mean time from accident to diagnosis was 19 hours (range 2.5–85 hr). At diagnosis, exacerbated pain was observed in 26 children, paraesthesia in eleven, motor deficit in seven, and diminished pulses in three. Mean time from accident to surgery was 21 hours. Mean follow-up was 15 months. The final outcome was remarkably good. At last follow-up, 24 children were pain free, with no functional or sensorial deficit. Aponeurotomy had been performed very late (43, 83, and 86 hr) in the three patients who developed functional deficit. There were no cases of infection even when surgery was performed late. Discussion: Most children treated for acute posttraumatic compartment syndrome achieve a good result even when the time from accident to treatment is long, often more than 12 hours. All patients with sequellae at the last follow-up in our series had undergone aponeurotomy more than 36 hours after the accident. Conclusion: This is the first series devoted exclusively to acute posttraumatic compartment syndrome of the leg in children. The results were generally good despite significant time from accident to treatment

The aim of this study was to document our experience of acute forearm compartment syndrome, and to determine the risk factors for requiring split skin grafting (SSG) and developing complications post fasciotomy. We identified from our trauma database all patients who underwent fasciotomy for an acute forearm compartment syndrome over a 22-year period. Diagnosis was made using clinical signs and/or compartment pressure monitoring. Demographic data, aetiology, management, wound closure, complications and subsequent surgeries were recorded. Outcome measures were the use of SSG and the development of complications following forearm fasciotomy. 90 patients were identified with a mean age of 33 yrs (range, 13–81 yrs) and a significant male predominance (n=82, p<0.001). A fracture of one or both of the forearm bones was seen in 62 (69%) patients, with soft tissue injuries causative in 28 (31%). The median time to fasciotomy was 12hrs (2–72). Delayed wound closure was achieved in 38 (42%) patients, with 52 (58%) undergoing SSG. Risk factors for requiring a SSG were younger age and a crush injury (both p<0.05). Complications occurred in 29 (32%) patients at mean follow-up of 11 (3–60) months. Risk factors for developing complications were a delay in fasciotomy of >6 hrs (p=0.018), with pre-operative motor symptoms approaching significance (p=0.068). Forearm compartment syndrome requiring fasciotomy predominantly affects males and can occur following either a fracture or soft tissue injury. Age is an important predictor of undergoing SSG for wound closure. Complications occur in a third of patients and are associated with an increasing delay in the time to fasciotomy

A total absence of acute compartment syndrome (ACS) was noted in 966 tibial fractures in African patients of diverse ethnic groups, reviewed retrospectively at our institution. According to general incidences reported in the literature, we should have experienced between 22 and 86 cases of acute compartment syndrome. The purpose of this prospective study was to confirm these findings and at the same time to try to find an explanation for this phenomenon. During a period of 1 year and 4 months, 257 tibial fractures were prospectively analyzed for clinical signs and late sequelae of acute compartment syndrome. In 156 of these patients, presenting 158 fractures of the tibia, the pressure in the anterior compartment was systematically measured. Not a single case, nor late sequel of ACS was diagnosed. The hypothesis we forward for this total absence of ACS is the effect of chronic high temperature surroundings in preventing ACS by safeguarding the arteriovenous gradient and lowering the vascular resistance. We propose that further investigation should be carried out to study this hypothesis

Purpose: Compartment syndrome is a severe complication of skeletal trauma. Intravital microscopy (IVVM) has demonstrated an inflammatory response to compartment syndrome (CS). The molecular mechanisms underlying this inflammatory response are unknown. The purpose of this study was threefold. First, a broad inflammatory cytokine profile was examined to determine the molecules responsible for white cell recruitment. As well, skeletal muscle expression of white cell adhesion molecules including P-Selectin, E-Selectin, Mac-1 and ICAM-1 were examined to assess the extent of white cell activation in target tissues. Finally, skeletal muscle apoptosis was measured to determine the magnitude of cell death. Method: Normal and neutropenic rats were randomised to either compartment syndrome or control groups. CS Animals were treated with 45 minutes of elevated intra-compartmental pressure (EICP) of the hindlimb. Fasciotomy was then performed, followed by 60 minutes of reperfusion. Control animals experienced no EICP. Blood was collected from carotid arterial lines used for pressure monitoring. Skeletal muscle tissue samples were collected from the EDL following reperfusion. Blood samples were obtained from carotid arterial lines and skeletal muscle was collected following reperfusion. A Multiplex assay was used to examine serum levels of 24 proinflammatory cytokines/chemokines. Skeletal muscle mRNA levels of P-Selectin, E-Selectin, Mac-1 and ICAM-1 were evaluated using real-time PCR. Finally, skeletal muscle apoptosis was measured by DNA laddering and a caspase-3 assay. Results: Neutropenic CS animals demonstrated a continuous increase in TNF-alpha levels, peaking at 700+/−350pg/ml by 60 minutes of reperfusion. TNF-alpha values for other groups did not increase. A 104-fold increase in ICAM-1 mRNA levels was observed in neutropenic CS rats while other groups showed no significant increase. There was no significant increase in any group for P-Selectin, E-Selectin, or Mac-1. Conclusion: This study is the first to attempt to describe the molecular inflammatory response in CS. Neutropenic CS animals demonstrated an upregulation in TNF-alpha and ICAM-1 mRNA levels. This likely represents an attempt to generate an inflammatory response in the neutropenic animals. Additional data at incremental timepoints is necessary to further characterize the molecular mechanisms. However, both TNF-alpha and ICAM-1 appear to be important in the mechanism of inflammatory activation in compartment syndrome

Purpose: Indomethacin may preserve tissue viability in compartment syndrome. The mechanism of improved tissue viability is unclear, but the anti-inflammatory effects may alter the relative contribution of tissue necrosis versus apoptosis to cellular injury. Existing studies have only considered indomethacin administration prior to induction of compartment syndrome. The purpose of this study was to determine the effect of timing of indomethacin administration on muscle damage in compartment syndrome, and to assess apoptosis as a cause of tissue demise. Method: Twenty-four Wistar rats were randomized to elevated intracompartmental pressure (EICP) for either 45 or 90 minutes (30mm Hg). In the 45 min group, indomethacin was withheld (group 1), given prior to induction of EICP (group 2) or given 15 min prior to fasciotomy (group 3). In the 90 min group, indomethacin was withheld (group 4) or provided 30 or 60 minutes prior to fasciotomy (groups 5 and 6). Intravital microscopy and histochemical staining assessed capillary perfusion, cell damage and inflammatory activation within EDL muscle. Apoptosis was assessed using ELISA staining for caspase-3. Groups were compared with one-way ANOVA (p< 0.05). Results: Perfusion improved in indomethacin-treated groups. Nonperfused capillaries decreased from group 1 (50.1±2.5), to groups 2 (38.4±1.8) and 3 (14.13±1.73)(p< 0.0001). Similarly, groups 5 and 6 had 25% fewer non-perfused capillaries compared to group 4 (p< 0.0001). Tissue viability improved in indo-methacin-treated groups. Groups 2 and 3 showed fewer damaged cells (1±0.5% and 8.7±2%) compared to group 1 (20±14%)(p< 0.0001). Groups 5 and 6 showed decreased cell damage (13±1% and 11±1%) compared to group 4 (18±1%) (p< 0.01). Apoptotic activity was present in compartment syndrome. At 30 minutes there were elevated caspase levels in EICP groups (0.47±0.08) compared to controls (0.19±0.02). However, indomethacin treated groups did not differ from controls with regards to caspase levels (p> 0.05). Conclusion: Indomethacin decreased cell damage and improved perfusion in compartment syndrome. The benefits of indomethacin were partially time dependent; some improvement in tissue viability occurred regardless of timing of administration. Although apoptosis was common in compartment syndrome, the protective effect of indomethacin does not appear to be related to apoptosis

Aim. To review current military orthopaedic experience and establish if there exists a consensus of opinion in how and if to perform fasciotomy of the foot and to guide other clinicians. Method. A questionnaire was sent to 10 DMS orthopaedic consultants to identify their experience with foot compartment syndrome and performing fasciotomies. Results. 50% had performed a foot fasciotomy (average 2, range 1-6) over an average of 6.2 years as consultant and an average of 7.3 months deployed. Most commonly two dorsal and a medial incision were used to decompress the foot, while one advocated not decompressing and accepting the contractures, a view consistent with some civilian literature. Discussion. The debate surrounding decompression stems from the rarity of the condition, the lack of consensus regarding the anatomy of the foot compartments and whether to accept the inevitable contractures by not decompressing. Given that foot compartment syndrome may not be seen during civilian training, then there is a requirement for guidance for the deploying military surgeon. Conclusion. DMS clinicians need to remain vigilant to compartment syndrome of the foot and especially in cases of crush or blast injury or of multiple fractures. If diagnosed or even if an impending compartment syndrome is suspected then the foot should be decompressed and the deployed orthopaedic surgeon should be capable of performing it

The detection and treatment of acute compartment syndrome following trauma is critical if contractures, delayed fracture healing and possible amputations are to be avoided. The current standard for monitoring relies on invasive compartment pressure measurements. These require an additional procedure and cause discomfort to the patient. This prospective clinical study investigates the relationship between the intra-compartmental pressure and soft tissue oxygenation (%StO. 2. ) measured non-invasively by near-infrared spectroscopy (NIRS) in patients at risk of acute compartment syndrome. Adults with acute tibial or radial diaphyseal fractures were recruited on admission to the orthopaedic trauma unit. Non-invasive and invasive monitoring over anterior tibial or volar forearm compartments was carried out from admission and continued post-operatively. The differential pressure (ΔDP) was calculated as the compartment pressure subtracted from the diastolic blood pressure. The threshold for fasciotomy was a ΔDP < 30mmHg. StO. 2. values were simultaneously recorded from the contralateral (uninjured) limb at the same site. All patients had the difference between the StO. 2. value on the injured and uninjured sides calculated (‘StO. 2. difference’). Sixty patients with tibial fractures and 5 patients with forearm fractures were recruited. The mean age was 39 years (S.D.18 years). Fourteen patients underwent a four-compartment lower leg fasciotomy determined by a ΔDP < 30mmHg. We have observed that the difference in StO. 2. between limbs (measured non-invasively) was significantly lower in patients undergoing a fasciotomy. This suggests that NIRS is able to detect a change in oxygenation of the soft tissues in trauma patients developing an acute compartment syndrome. We are optimistic that near-infrared spectroscopy (NIRS) will be a reliable new non-invasive technique for detection of an acute compartment syndrome

Chronic exertional compartment syndrome of the foot is well recognised. There has been debate over the exact number and location of compartments. While the medial compartment has been consistently reported, the exact anatomy of the fasciotomy has been poorly documented in orthopaedic literature. Over a four year period (2003–7) five patients (seven feet) with history and examination findings compatible with chronic exertional compartment syndrome affecting the medial compartment of the foot were treated in our unit. There were three female patients and two males, average age 23 (17–34). Assessment was made using the Stryker compartment pressure monitor inserted into the compartment following exertion. The measurements were compatible with chronic exertional compartment syndrome according to the Pedowitz criteria. The patients then underwent complete surgical release of the medial compartment of the foot. This involved two small oblique incisions, over the proximal and distal ends of the muscle belly of abductor hallucis, the fascia on the superficial and deep surfaces was then released, thus releasing the distal end of the tarsal tunnel. Decompression was bilateral in one, sequential in one and unilateral in three. Three patients also had surgical treatment of chronic compartment syndrome elsewhere in their lower limbs. One patient underwent a simultaneous calcaneal osteotomy for a planovalgus foot. Preoperative post exertional compartment pressure measurements were 67.8 (32–114) at 1 minute and 50.2 (28–97) at 5 minutes. At an average of 21 (9–57) months follow up all but one patient had significant relief of their symptoms. We recommend that the surgical treatment of chronic exertional compartment syndrome affecting the medial compartment of the foot should involve full release of the fascia both superficial and deep to abductor hallucis. It is safe to perform this bilaterally and in association with other lower limb decompressions as required

Purpose: Objective, prospective study of professional athletes with chronic forearm compartment syndrome and treatment. Materials and methods: We studied 18 cases of chronic compartment syndrome in 12 patients. The sample consisted of 12 men in an age range of 17 to 33. Both forearms were involved in six cases. Sixteen patients were motorcyclists and two were windsurfers. The clinical picture was compatible with chronic compartment syndrome. For confirmation the compartment pressure was measured after simulating each person’s activity. The test was considered positive when the pressure measured 15′ after exercise was > 15 mmHg. Results: The 12 patients presented clinical pictures and compartment pressure test results compatible with severe chronic compartment syndrome of the forearm with loss of sensitivity and proprioception. We found compartment pressures of 15–20 mmHg 15′ after exercise in two cases, 20–30 mmHg in six cases and > 30 mmHg in ten. The flexor and extensor compartments of the forearm were released by minimally invasive surgery. Conclusions: We can conclude that fasciotomy was followed by clinical improvement with no evidence of loss of strength, and the athlete was able to play again within a short time

Purpose. Compartment syndrome is a limb threatening condition. Prior research has been limited by an inability to assess functional and histologic changes in muscle over time. This study was designed to assess and quantify functional deficits and histologic changes following acute compartment syndrome of the lower limb in a novel rat model. Method. Twenty-three male Wistar rats were trained to perform an incentive-based standard task on an optical gait tracking system. Animals were then randomized to three groups: Control (n=4), Sham (n=4) and Compartment Syndrome (CS, n=15). Control and sham animals had no elevation of intracompartmental pressure, while CS animals had elevated intracompartmental pressure to 30mmHg for 180 minutes in the anterior compartment of the left hind limb using a saline infusion technique. Following intervention, gait analysis was performed at 2hrs, 24hrs, 48hrs, 72hrs and 7days following injury. Several parameters for the injured hind limb were analyzed including: print area, print intensity, maximum contact timing, duty cycle and stance phase time. A 2-way ANOVA with Bonferroni post-hoc analysis was performed. The EDL muscle was harvested (n=17), fixed in formalin and prepared with an H&E stain. Mid-muscle sections were analyzed by a blinded senior pathologist for cell infiltration, necrosis and regeneration. Results. Function Changes: Mean print intensity was 96.5518.7 at 48hrs for CS animals, compared to 145.538.2 in control animals and 144.9612.71 in sham animals (p<0.001). At the 2hrs, 24hrs, and 48hrs time intervals post injury the CS animals showed significant decreases in print width (p<0.001), maximum contact (p<0.001), mean print intensity (p<0.001) and stance phase (p<0.01). There were no significant differences between baseline and 72hr results for any gait parameter (p>0.05). Histologic Changes: Cellular infiltration was noted at 24hrs, peaked at 48hrs and was still present at 7 days to a lesser degree. Necrosis began as early as 24hrs post injury and also peaked by 48hrs and returned to baseline levels by 7days. Minor regenerative changes were identified as early as 24hrs however the majority of changes were identified at 7 days post-injury. Conclusion. Developing and evaluating animal models for the study of compartment syndrome is essential for better understanding the condition and testing new treatment modalities. Gait analysis was a reproducible means of assessing function after compartment syndrome. Animals demonstrated an antalgic gait pattern demonstrated by decreased stance phase, decreased print intensity, and increased print width, with recovery demonstrated by 72hrs post-injury. Defining the histologic changes such as necrosis, cellular infiltration and regeneration associated with compartment syndrome has allowed us to further understand the evolving pathology of compartment syndrome over time. This study facilitates the evaluation of functional and histologic testing for the evaluation of new therapeutic interventions

This prospective clinical study investigates the relationship between intra-compartmental pressure and soft tissue oxygenation (StO2) measured non-invasively by near-infrared spectroscopy (NIRS) in patients at risk of acute compartment syndrome. Patients (over 13 years) with fractures of the tibial diaphysis or high-energy fractures of the forearm or distal radius, or patients with soft tissue injury were recruited. Non-invasive and invasive monitoring was carried out pre and post operatively. The ‘Delta P’ value (DP) was calculated as the compartment pressure subtracted from the diastolic blood pressure. The threshold for fasciotomy was a DP < 30mmHg. Non-invasive tissue saturation measurements and pressure measurements were taken from the same compartment (anterior tibial or volar forearm). StO2 values were simultaneously recorded from the contralateral (uninjured) limb at the same anatomical site. All patients had the difference between the StO2 value on the injured and uninjured sides calculated (‘StO2 difference’). 42 patients with tibial diaphyseal fractures, 2 patients with forearm fractures and one case with thigh swelling were recruited to the study. The mean age was 40 years (SD 17 years). 11 patients underwent a four-compartment lower leg fasciotomy determined by a DP < 30mmHg. Patients who required a fasciotomy had an ‘StO2 difference’ that was 20% lower (p = 0. 002) compared to those who did not develop acute compartment syndrome. This suggests that patients who require a fasciotomy have reduced StO2 values on their injured legs compared to the contralateral (uninjured) side. We have observed that non-invasive StO2 measurements for patients over 13 years at risk of acute compartment syndrome, correlates with the requirement for a fasciotomy as defined by P < 30mmHg. We are optimistic that near-infrared spectroscopy (NIRS) will be a reliable new non-invasive technique for detection of an acute compartment syndrome

Purpose: Chronic compartment syndrome of the forearm is considered to be exceptional but may be underestimated. Compartment syndrome of the upper limb is recognized but generally considered to be non-specific compared with acute Wolkmann syndrome. Chronic compartment syndrome, or “subacute compartment syndrome” is also well known but often associated with exertion of the lower limbs in athletes. The association of a compartment syndrome of the upper limb and a chronic compartment syndrome was just recently described since the first publication appears to be the paper by Tompkins in 1997. Scare reports have reported a few cases since then. Material and methods: We report our personal experience with ten cases with a minimum follow-up of six months. Results: Compared with the literature, the analysis of our series provides an explanation of the clinical, diagnostic, and therapeutic features of chronic exercise syndromes of the forearm. Discussion: A better awareness of this pathological condition will probably enable earlier and more surgical care of these athletes who are handicapped by these syndromes well known in the motocross world as “forearm tetany” or “armpump””

To assess outcomes following a radical approach to cases of compartment syndrome in which a significant degree of muscle necrosis is found, 4 paediatric and adolescent patients with a delayed diagnosis of compartment syndrome in which muscle necrosis in single or multiple compartments were treated by radical debridement of necrotic tissue and reconstruction of the anterior compartment through transfer of peroneus brevis to extensor digitorum and hallucis longus tendons. Where suitable, a free vascularised and innervated gracilis muscle transfer to the tibialis anterior tendon stump was carried out with anastomosis of the nerve to gracilis to the deep peroneal nerve. Free gracilis muscle transfer was functional in one of the two patients whilst peroneus brevis transfer to extensor digitorum and hallucis tendons was functional in all three patients. In one patient, radical debridement resulted in loss of the entire anterior compartment requiring permanent ankle foot orthosis. All others had recovery of protective foot sensation and at minimum follow-up of 12 months were walking unaided. Infection was not seen in any patient. Prompt fasciotomy, debridement and reconstruction for late diagnosis of compartment syndrome proved limb-saving in our patients

Purpose: Severe compartment syndrome is associated with renal failure, end organ damage, and systemic inflammatory response syndrome (SIRS). Intravital videomicroscopy (IVVM) is a useful tool to study capillary perfusion and inflammation in end organs such as the liver and lungs. In this study, the systemic effect of hindlimb compartment syndrome was studied using hepatic IVVM. The purpose was to measure the effect of increased hindlimb intracompartmental pressure on hepatocyte viability, inflammation, and blood flow in a rodent model. Method: Ten Wistar rats were randomised into control (C) and Compartment Syndrome (CS) groups. Animals were anaesthetized with 5 % isoflurane. Mean arterial pressure was monitored using a carotid artery catheter. Elevated intracompartmental pressure (EICP) was induced by saline infusion into the anterior compartment of the hind limb and maintained for 2 hours between 30–40mmHg in the CS group. Two hours following fasciotomy, the liver was analyzed using IVVM to quantify capillary perfusion as a measure of microvascular dysfunction. The numbers of adherent and rolling leukocytes in venules and sinusoids were quantified to measure the inflammatory response. Irreversible hepatocyte injury was measured using a fluorescent vital dye which labels the nuclei of severely injured cells. Results: Hepatocellular injury was significantly higher in the CS group (325±103 PI labeled cells/10-1 mm2) compared to controls (30±12 PI labeled cells/10-1 mm2)(p=0.0087). The number of adherent venular white blood cells (WBC) was significantly higher for the CS group (5±2/hpf) than controls (0.2±0.2)(p=0.0099). Volumetric blood flow was not significantly different between CS and controls. Conclusion: After only 2 hours of compartment syndrome in this animal model, the number of activated white blood cells increased 25-fold and liver cellular injury increased 10-fold compared to controls. Marked systemic inflammation and hepatocellular damage was detected in response to isolated limb compartment syndrome. Compartment syndrome is a low-flow ischemia/reperfusion injury with a profound inflammatory response. Further research into the severe end-organ damage associated with compartment syndrome is required

The threshold for decompression in acute compartment syndrome is quoted as a pressure difference between the compartment and diastolic blood pressure of less than 30mmHg. This study reports the findings of continuous compartment pressure monitoring in children who underwent tibial osteotomies. In this prospective observational study, twenty seven children who underwent tibial osteotomies had anterior compartment pressures monitored using a transducer-tipped probe for a minimum of 72 hours following surgery. Pressure data were collected hourly together with evidence of clinical signs, symptoms and patterns of analgesic use. Patients were also reviewed for late sequelae of compartment syndrome. One case of compartment syndrome were encountered. Pressure differences (diastolic BP - compartment pressure) were found to vary widely, with many children exceeding the threshold for decompression but without manifesting other signs of compartment syndrome. Fasciotomies were not performed in view of the conflicting evidence and subsequent review confirmed the absence of late sequelae. In these children, low diastolic blood pressures were a common but normal feature. The prevalence of compartment syndrome was 3.7% (1/27). The positive predictive value of using the adult threshold was 7.1%; the negative predictive value was 100%. We conclude that the threshold for decompression as applied to adults is unsuitable for use in children inasmuch as a positive result would lead to a correct diagnosis in only 7.1% of children. A negative test is more useful in correctly excluding compartment syndrome in 100% of the children studied