The Effect of Focused Instruction on Orthopaedic Surgery Residents’ Ability to Objectively Measure Intracompartmental Pressures in a Compartment Syndrome Model

Morris, Michael; Harper, Benjamin L.; Hetzel, Scott; Shaheen, Michael; Davis, Alan T.; Nemeth, Blaise A.; Halanski, Matthew A.

doi:10.2106/jbjs.m.00582

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…We used a model similar to previously described models. 4,13,19 We attached 3 gravity in-flow intravenous tubing kits to two 1-L bags of sterile 0.9% normal saline solution. An adult-sized blood pressure cuff with attached sphygmomanometer was affixed around each bag of fluid, and the cuffs were inflated to 250 mm Hg.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot

et al. 2019

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Background: Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression. Methods: Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies. Results: Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005). Conclusion: Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments. Clinical Relevance: The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.

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Section: Methodsmentioning

confidence: 99%

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot

et al. 2019

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“…The handheld intracompartmental monitoring device with a side-ported needle has been shown to be extremely accurate in the laboratory 8 . In our recent article 9 , however, we found that trainees routinely made many technical errors using the device in a laboratory-based simulation. Furthermore, residents who made technical errors were more likely to make inaccurate pressure measurements.…”

Section: Resultsmentioning

confidence: 91%

“… In our previous study 9 , the majority of trainees (79%) who did not receive formal training in the use of an intracompartmental pressure monitoring device committed some technical error at baseline. Improper purging and zeroing were the most common errors.…”

Section: What To Watch Formentioning

confidence: 88%

“… How would you recommend teaching orthopaedic residents to accurately measure intracompartmental pressures? We used a simple didactic teaching session, the content of which is included as an appendix in our article 9 . However, due to the design of the study, the residents also had three separate “hands-on” sessions using the compartment pressure monitors.…”

Section: Clinical Commentsmentioning

confidence: 99%

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Intracompartmental Pressure Monitoring Using a Handheld Pressure Monitoring System

Halanski

Morris

Harper

et al. 2015

JBJS Essential Surgical Techniques

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OverviewIntroductionWe describe the correct technique for measuring compartment pressure with a handheld device to diagnose compartment syndrome.Step 1: Device PreparationProper preparation of the handheld pressure monitoring device (Stryker Surgical, Kalamazoo, Michigan) is critical to ensure that the device performs appropriately.Step 2: Identification of the Compartment of InterestThe needle must be placed in the proper location to appropriately measure a compartment’s pressure.Step 3: InjectionInject saline solution from the pressure monitoring device to clear any soft tissue from the side port on the needle that could result in inaccurate pressure measurements.Step 4: Stabilization and Pressure ReadingThe pressure must reach a stable state before it is recorded; different pressure thresholds for decompression have been recommended in the literature.Step 5: Repeat MeasurementsAs mistakes can be made with any single measurement, accuracy may be improved by repeating steps 1 through 4 and averaging the results.Step 6: Additional CompartmentsAfter the reading is obtained, move on to any additional compartment(s) that need to be evaluated, repeating the steps listed above.ResultsThe handheld intracompartmental monitoring device with a side-ported needle has been shown to be extremely accurate in the laboratory.IndicationsContraindicationsPitfalls & Challenges

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“…For example, when we studied the effects of an educational program on resident's ability to measure compartment pressures, little formal education, at our center, was being performed on the subject. Generally, the procedure is quite simple, so perhaps that is why the intervention was productive [11].…”

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confidence: 99%

Editor's Spotlight/Take 5: To Cast, to Saw, and Not to Injure: Can Safety Strips Decrease Cast Saw Injuries?

Leopold

2016

Clinical Orthopaedics &Amp; Related Research

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The Effect of Focused Instruction on Orthopaedic Surgery Residents’ Ability to Objectively Measure Intracompartmental Pressures in a Compartment Syndrome Model

Cited by 7 publications

References 23 publications

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot

Intracompartmental Pressure Monitoring Using a Handheld Pressure Monitoring System

Editor's Spotlight/Take 5: To Cast, to Saw, and Not to Injure: Can Safety Strips Decrease Cast Saw Injuries?

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