Measurement of tissue hardness: can this be a method of diagnosing compartment syndrome noninvasively in children?

Abstract

In order to assess the feasibility of using the measurement of tissue hardness as a method of diagnosing compartment syndrome noninvasively in children, a simple hand-held device to measure tissue hardness was fabricated. The relationship between hardness and compartmental pressure was studied in an experimental model and in three fresh amputated lower limbs. Normal tissue hardness of the forearm was measured in 189 children and 20 adults to identify the factors that influence normal tissue hardness. The reproducibility of measurement of tissue hardness was assessed on the experimental model, on the amputated limbs and in normal individuals. Experimental data from this study suggest that there is a nonlinear relationship between intracompartmental pressure and tissue hardness. The study also shows that tissue hardness can be measured reproducibly in the forearm of children with the device. Several factors influence tissue hardness such as the age of the child, the site of measurement on the limb, the hand dominance and active muscle contraction. These factors may affect the specificity of this measure as a screening tool for diagnosing compartment syndrome. Further refinement of the measuring device and well designed clinical trials are needed to establish whether compartmental syndrome can be diagnosed reliably by measuring tissue hardness noninvasively.

Special Aspects of Forearm Compartment Syndrome in Children

“…But still in 1998, less than 50 % of hospitals in ie the United Kingdom had dedicated devices for measuring intracompartmental pressure and it is likely that in less affluent countries even fewer centers would have this opportunity available (Joseph et al, 2006). And this even despite the fact that "Compartment Syndrome" is recognized as a real surgical emergency.…”

“…This can be done by repeated measurements involving skin punctures on each occasion or by leaving an indwelling catheter till the clinical situation warrants it. Both of these options have obvious disadvantages, particularly in children (Battaglia et al, 2002;Bibbo et al, 2000;Choi et al, 2010;Joseph et al, 2006;Kowtharapu et al, 2008;Krahn, 2005;Mars & Hadley,1998;Ouellette, 1998;Paletta & Dehghan, 1994). Therefore, in allday practice in children continous monitoring is used less and in the majority of cases, compartment pressure is measured in the operating room after induction of general anesthesia to confirm the diagnosis and document the compartment pressure before fasciotomy is performed (Paletta & Dehghan, 1994).…”

“…A Compartment Syndrome has either extrinsic or intrinsic causes, and will be described as acute, subacute, chronic, or recurrent (Bae et al, 2001;Grottkau et al, 2005;Joseph et al, 2006;Krahn, 2005;Mars & Hadley, 1998;Mubarak & Carroll, 1979;Ouellette, 1998;Paletta & Dehghan, 1994;Prasarn & Ouellette, 2009, 2011Ragland et al, 2005;Ramos et al, 2006;Sawyer, 2010;Wright, 2009 Blakemoore et al, 2000;Grottkau et al, 2005;Krahn, 2005;Krenzien et al, 1998;Mubarak & Carroll, 1979;Ouellette, 1998;Paletta & Dehghan, 1994;Preis, 2000;Ragland et al, 2005;Ramos et al, 2006;Wright, 2009). …”

“…The study also showed that tissue hardness can be measured reproducibly in the forearm of children with this device. However, further refinement of the measuring device and well designed clinical trials are needed to establish whether CS can finally be diagnosed reliably by measuring tissue hardness non-invasively alone (Joseph et al, 2006).…”

“…In summary, since most of the classic signs and symptoms of Compartment Syndrome are unreliable or unobtainable in the pediatric age group, a high clinical suspicion is needed to make an accurate and timely diagnosis (Bae et al, 2001;Bibbo et al, 2000;Choi et al, 2010;Johnson & Chalkiadis, 2009;Joseph et al, 2006;Kadiyala & Waters, 1998;Paletta & Dehghan, 1994;Prasarn & Ouellette, 2011;Sawyer et al, 2010, Wright, 2009Yang & Cooper, 2010). Additional tests, such as compartment pressure measurements might be used to establish the diagnosis further (see next paragraph) (Mars & Hadley, 1998;Paletta & Dehghan, 1994).…”