MULTICENTRE CLINICAL TRIAL OF A CONTINUOUS COMPARTMENTAL PRESSURE DEVICE IN PATIENTS WITH LONG BONE FRACTURES

Acute compartment syndrome (ACS) is an orthopaedic emergency that can develop after a wide array of etiologies. Continuous pressure monitoring may contribute to the early diagnosis of ACS. This multicenter prospective study evaluated a new compartmental pressure monitor that reports continuous pressures in real-time. Patients with acute long bone fractures were prospectively enrolled from six Canadian academic centers after obtaining informed consent. The study device was inserted in the compartment deemed by the attending surgeon most likely to develop ACS. Intracompartmental pressure (ICP) was continuously measured for up to 18 hours. Patients were simultaneously monitored for clinical signs of ACS and their vitals and pain levels were recorded. Compartment pressures were plotted along with perfusion pressures for the duration of the device measurements. Patients were grouped by timing of device insertion (pre-operative or post-operative) and by AO/OTA fracture classification to look for trends in ICP over time and correlations with clinical data. One hundred patients were enrolled between November 2020 and November 2022. There were 68 males and 32 females. The mean age was 41 years (range, 17–80). Eighty-nine patients received the device post-operatively and eleven received it pre-operatively. There were no complications related to the use of the device. Consistent with previously published literature (McQueen et al. J Bone Joint Surg Br. 1990;72(3):395–7), the post-operative ICPs were found to be considerably higher than pre-operative ICPs (as shown in Table 1) but trended downwards very quickly if the ICP was not clinically significant. One patient developed ACS post-operatively; their pressures exhibited the same higher initial baseline measurements, but instead of steadily decreasing, the pressure plateaued at a relatively high level and then stayed consistently above the perfusion pressure (Figure 1). These data suggest that the trend of the curve in continuous pressure monitoring appears to be more significant than absolute pressure – which is a distinct change in understanding from the standard literature on diagnosing ACS. One patient with a fractured tibia illustrated a steep trend upwards in ICP pre-operatively, which pre-dated clinical symptoms by four hours. The patient underwent fasciotomy for ACS at the time of fracture fixation. Our results suggest that this device is a reliable and easy to use commercially available option for continuous pressure monitoring. We found that post-operative ICP can be higher than would have been acceptable in the literature, but usually dropped rapidly. These findings agree with the current understanding on the difference between pre-operative and post-operative ICPs. Further examination of the continuous upwards or downwards trends in compartmental pressure monitoring and the accompanying perfusion pressures should allow us to diagnose elevated ICP many hours earlier than would be clinically possible with the usual symptom complex of ACS. This could reduce the chance of a false positive or a false negative in dealing with patients at high risk of ACS, thus preventing unnecessary fasciotomies and drastically reducing the chance of muscle necrosis during the management of these difficult long bone fractures. For any figures or tables, please contact the authors directly.

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