Acute compartment syndrome (ACS) occurs after muscle injury and is characterised by increased pressure in the muscle compartment that can result in devastating complications if not diagnosed and treated appropriately. ACS is currently confirmed by repeated needle sticks to measure the compartment pressure using a hand-held compartment pressure monitor. This approach is often not reproducible and is not appropriate for continuous monitoring. To address the shortcomings of currently available technology we are developing an implantable micro-device that will measure compartment pressure directly and continuously over the 24 hours critical period following injury using a radio frequency identification (RFID) platform integrated with a MEMS capacitive pressure sensor. The prototype implantable device measuring 3mmx3mm consists of a capacitive pressure sensor, a sensor readout circuitry, an antenna and a radio frequency reader. A prototype sensor was packaged in Silicone gel (MED-6640, Nusil Technology LLC) for ex vivo and in vivo testing in three compartment models. First, it was tested ex vivo in an airtight vessel using a blood pressure monitor to pump air and increase the pressure inside the vessel. Second, it was implanted in a muscle compartment of a fresh porcine hind limb and an infusion pump with normal saline was used to raise the tissue pressure. Third, it was implanted in the posterior thigh muscle of a rat where the pressure was increased by applying a tourniquet around the thigh. The readings were compared with those from a hand-held Stryker Intra-compartmental Pressure Monitor System used in the trauma room.Significance
Methods
MRI scanning of spinal patients at the Primary Care Triage stage is pivotal in reducing inappropriate referrals into Secondary Care. A retrospective study was undertaken. Details of patients from spinal triage clinics referred for MRI scan were collated together with a provisional diagnosis. Following imaging the results and management plan were documented. 2191 Patients referred via GP's to Physiotherapy Specialist- lead spinal triage clinics from April to September 2009 inclusive. Referred to a spinal consultant routine/urgent, Managed conservatively, Failed to attend for MRI scanning or MRI cancelled, Sent for scanning for reassurance and discharged. Of 2191 patients seen in a 6-month period 194 (9%) were referred for MRI of which 81 (41%) were referred on to spinal consultant. This equates to 3.7% of the total number of patients triaged. Specialist physiotherapy diagnosticians with access to MRI scanning, allows simultaneous treatment and seamless transfer to spinal consultants for surgical intervention if appropriate1. This process is used effectively to manage large numbers of spinal referrals and minimises the number of patients seen unnecessarily in secondary care1. This is only possible with close multidisciplinary team working2.
