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Diagnosis of Acute Compartment Syndrome: Direct Measurement of Tissue Oxygenation

Mok, James Moon MD*; Hansen, Erik N. MD; Kang, Heejae BS; Kandemir, Utku MD

doi: 10.1097/BTO.0b013e3182488444

We present a technique and feasibility study of continuous measurement of intramuscular tissue oxygenation as a potential novel approach to the diagnosis of acute extremity compartment syndrome. Polarographic probes were inserted percutaneously into the anterior compartment of the leg to measure the partial pressure of oxygen (PmO2). Five patients underwent open reduction internal fixation of ankle fracture under a thigh tourniquet. With application of the tourniquet, the mean PmO2 decreased rapidly from 26.62 to 0.52 mm Hg (range, 0.1 to 1.4 mm Hg). Eleven patients underwent monitoring of tissue oxygenation after intramedullary nailing for an isolated closed tibia fracture. No compartment syndrome occurred. In the absence of compartment syndrome, 1.35% of PmO2 measurements spanning 424 hours fulfilled the predefined warning criterion of PmO2<10 mm Hg. Our data establish the feasibility of measuring tissue oxygenation and its responsiveness to ischemia. In contrast to compartment pressure, PmO2 measurements after tibia fracture rarely fulfilled the warning criterion in the absence of compartment syndrome. A floor PmO2 value of nearly zero was established in live ischemic muscle. Tissue oxygenation may represent a minimally invasive, physiologic, and specific method for diagnosing compartment syndrome.

*Orthopaedic Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, WA

Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA

E.N.H. received a grant from the Orthopaedic Trauma Association for this work.

The views expressed are those of the authors and do not reflect the official policy or position of the US Army, Department of Defense or the US Government.

The authors declare that they have nothing to disclose.

Address correspondence and reprint requests to Utku Kandemir, MD, Orthopaedic Trauma Institute, San Francisco General Hospital, 2550 23rd St, Building 9, 2nd Floor, San Francisco, CA 94110. E-mail:

Received December 14, 2011

Accepted December 27, 2011

© 2012 Lippincott Williams & Wilkins, Inc.