Detection of Acute Compartment Syndrome Using Ultrasound

Background: Acute Compartment Syndrome (ACS) is an orthopaedic emergency. The diagnosis of ACS remains challenging and missed or delayed diagnosis of ACS remains a problem. Physical exam and invasive techniques for measuring compartment pressures (CPs) have been suggested as being poor sensitivity and specificity. Noninvasive techniques for assessment of compartment syndrome have had limited success so far in clinical practice. We have developed a simple and intuitive ultrasonography (US) based method, to detect ACS.

Methods: A commercially available pressure measurement gauge was added to a standard US transducer. Compartment width (CW), as well as the pressure applied to the compartment (Compartment-Press Pressure = CPP), were recorded. A model of ACS was created in 6 cadaver legs. A fluid column was used to generate CPs of 0, 30, 45, 60 and 75mmHg in the anterior compartment of all legs. CW & CPP was measured by 3 independent orthopaedic surgeons.

Results: Excellent correlations were observed for CW (R² ranging from 0.64 to 0.97) and CPP (R² ranging from 0.84 to 0.96) for individual legs. However, moderate correlations were observed when assessing together the data from all 6 legs (R² = 0.49 for CW, R² = 0.7 for CPP).

Conclusion: Ultrasonography may be able to provide valuable information in the assessment of acute compartment syndrome. This technology seems to be more suited for continuous observation of a single patient than one measurement diagnosis. Clinical trials are needed to assess the utility of ultrasonographic indexes in early detection of acute compartment syndrome.