Search

Serial examination and direct measurement of intracompartmental pressure (ICP) are suboptimal strategies for the detection of acute compartment syndrome (CS) because they are operator-dependent and yield information that only indirectly reflects intracompartmental muscle perfusion. As a result, instances of unnecessary fasciotomy and unrecognized CS are relatively common. Recently, near-infrared spectroscopy (NIRS)-based systems for compartment monitoring have generated interest as an adjunct tool. Under ideal conditions, NIRS directly measures the oxygenation of intracompartmental muscle (StO 2 ), thereby obviating the challenges of interpreting equivocal clinical examination or ICP data. Despite these potential advantages, existing NIRS sensors are plagued by technical difficulties that limit clinical utility. Most of these limitations relate to their transcutaneous design that makes them susceptible to both interference from intervening skin/subcutaneous tissue, underlying hematoma, and instability of the skin-sensor interface. Here, we present a flexible, wireless, Bluetooth-enabled, percutaneously introducible intramuscular NIRS device that directly and continuously measures the StO 2 of intracompartmental muscle. Proof of concept for this device is demonstrated in a swine lower extremity balloon compression model of acute CS, wherein we simultaneously track muscle oxygenation, ICP, and compartment perfusion pressure (PP). The observed StO 2 decreased with increasing ICP and decreasing PP and then recovered following pressure reduction. The mean change in StO 2 as the PP was decreased from baseline to 30 mmHg was -7.6%. The mean difference between baseline and nadir StO 2 was -17.4%. Cross-correlations (absolute value) describing the correspondence between StO 2 and ICP were >0.73. This novel intramuscular NIRS device identifies decreased muscle perfusion in the setting of evolving CS., (© 2022 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)

»: Spinopelvic dissociation is a complex and variable injury pattern that requires an integrated, multidisciplinary team including orthopaedic trauma and spine surgeons., »: Protocols and efficient channels of communication should be in place at tertiary Level-I trauma centers to ensure appropriate and timely treatment of patients with spinopelvic dissociation., »: Patients with spinopelvic dissociation may present with acute neurological deficits and impending cauda equina syndrome, necessitating urgent, coordinated care., »: Lumbopelvic fixation with sacroiliac screws yields a stable, multiplanar construct that connects the spine to the pelvis and allows for early mobilization., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A728)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)