Top

Journal of Orthopaedics and Traumatology

Published in:

Open Access 01-12-2021 | Original article

The association between intracompartmental pressure and skeletal muscle recovery after tibial diaphyseal fractures: an ambispective cohort study

Authors: Shengjie Tian, Shimin Chang, Yaogang Lu, Jianhua Zhu, Xuqiang Kong

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2021

Abstract

Background

Due to the special anatomy of the lower leg, tibial diaphyseal fracture causes increased intracompartmental pressure (ICP). Not only is this increased ICP the manifestation of skeletal muscle injury, but it induces further deterioration of the injury. The aim of this study was to assess the association between short-term ICP elevation and long-term skeletal muscle recovery after severe limb trauma.

Methods

In this single-center ambispective cohort study, we retrospectively screened and recruited a cohort of tibial diaphyseal fracture patients with integrated ICP data during the early post-traumatic period, and performed a prospective observational study to evaluate their skeletal muscle recovery through long-term follow-up and MR imaging after the removal of the implants. We analyzed the association between ICP elevation and skeletal muscle recovery using statistical methods.

Results

A total of 46 patients with healed fractures underwent intramedullary nail removal and MR imaging. The absolute values of the Pearson product-moment correlation coefficients between various ICP parameters and the cross-sectional area ratio (CSAR) ranged from 0.588 to 0.793, and the correlation coefficients between the ICP parameters and the average T2-weighted signal intensity ratio (T2SIR) varied from 0.566 to 0.775. Statistically significant associations were observed between the ICP parameters and the MR imaging parameters when simple linear regression analysis was performed. Among the ICP parameters, the accumulated ΔP (ΔP = diastolic blood pressure minus ICP) had the highest determination coefficient and explained 62.1% and 59.1% of the variance in CSAR and T2SIR, respectively.

Conclusions

Short-term ICP elevation was associated with long-term skeletal muscle recovery following tibial diaphyseal fracture, especially for ICP data that integrated time factors.

Level of evidence

Level 3.

Grutter R, Cordey J, Buhler M, Johner R, Regazzoni P (2000) The epidemiology of diaphyseal fractures of the tibia. Injury 31(Suppl 3):C64-67CrossRef

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697CrossRef

Wennergren D, Bergdahl C, Ekelund J, Juto H, Sundfeldt M, Moller M (2018) Epidemiology and incidence of tibia fractures in the Swedish fracture register. Injury 49:2068–2074

Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S (2015) Incidence and epidemiology of tibial shaft fractures. Injury 46:746–750CrossRef

Donaldson J, Haddad B, Khan WS (2014) The pathophysiology, diagnosis and current management of acute compartment syndrome. Open Orthop J 8:185–193CrossRef

Via AG, Oliva F, Spoliti M, Maffulli N (2015) Acute compartment syndrome. Muscles Ligaments Tendons J 5:18–22PubMedPubMedCentral

Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S (2010) Compartment syndrome of the lower leg and foot. Clin Orthop Relat Res 468:940–950CrossRef

von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, Jupiter JB, Vrahas MS (2015) Diagnosis and treatment of acute extremity compartment syndrome. Lancet 386:1299–1310CrossRef

Oyster N, Witt M, Gharaibeh B, Poddar M, Schneppendahl J, Huard J (2015) Characterization of a compartment syndrome-like injury model. Muscle Nerve 51:750–758CrossRef

10.

Xu Y, Bai Y, Li Q, Shen X, Jiang L (2010) Experimental study of prognosis of chronic compartment syndrome. Connect Tissue Res 51:419–425CrossRef

11.

Serrano AL, Munoz-Canoves P (2010) Regulation and dysregulation of fibrosis in skeletal muscle. Exp Cell Res 316:3050–3058CrossRef

12.

Tanaka NI, Kanehisa H (2014) Applicability of single muscle CSA for predicting segmental muscle volume in young men. Int J Sports Med 35:608–614

13.

Noseworthy MD, Davis AD, Elzibak AH (2010) Advanced MR imaging techniques for skeletal muscle evaluation. Semin Musculoskelet Radiol 14:257–268

14.

Costa AF, Di Primio GA, Schweitzer ME (2012) Magnetic resonance imaging of muscle disease: a pattern-based approach. Muscle Nerve 46:465–481CrossRef

15.

Commean PK, Tuttle LJ, Hastings MK, Strube MJ, Mueller MJ (2011) Magnetic resonance imaging measurement reproducibility for calf muscle and adipose tissue volume. J Magn Reson Imaging 34:1285–1294CrossRef

16.

Flores DV, Mejia Gomez C, Estrada-Castrillon M, Smitaman E, Pathria MN (2018) MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance. Radiographics 38:124–148

17.

Laakman RW, Kaufman B, Han JS, Nelson AD, Clampitt M, O’Block AM, Haaga JR, Alfidi RJ (1985) MR imaging in patients with metallic implants. Radiology 157:711–714

18.

Singh DR, Chin MS, Peh WC (2014) Artifacts in musculoskeletal MR imaging. Semin Musculoskelet Radiol 18:12–22

19.

Tian S, Lu Y, Liu J, Zhu Y, Cui Y, Lu J (2016) Comparison of 2 available methods with Bland-Altman analysis for measuring intracompartmental pressure. Am J Emerg Med 34:1765–1771

20.

McQueen MM, Duckworth AD, Aitken SA, Court-Brown CM (2013) The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome. J Bone Joint Surg Am 95:673–677CrossRef

21.

McQueen MM, Court-Brown CM (1996) Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br 78:99–104CrossRef

22.

Duckworth AD, McQueen MM (2014) Continuous intracompartmental pressure monitoring for acute compartment syndrome. JBJS Essent Surg Tech 3:e13

23.

Schweitzer L, Geisler C, Pourhassan M, Braun W, Glüer C-C, Bosy-Westphal A, Müller MJ (2015) What is the best reference site for a single MRI slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults? Am J Clin Nutr 102:58–65

24.

Kanehisa H, Ikegawa S, Tsunoda N, Fukunaga T (1994) Cross-sectional areas of fat and muscle in limbs during growth and middle age. Int J Sports Med 15:420–425CrossRef

25.

van den Brand JG, Nelson T, Verleisdonk EJ, van der Werken C (2005) The diagnostic value of intracompartmental pressure measurement, magnetic resonance imaging, and near-infrared spectroscopy in chronic exertional compartment syndrome: a prospective study in 50 patients. Am J Sports Med 33:699–704CrossRef

26.

Exeter D, Connell DA (2010) Skeletal muscle: functional anatomy and pathophysiology. Semin Musculoskelet Radiol 14:97–105CrossRef

27.

Huijing PA, Jaspers RT (2005) Adaptation of muscle size and myofascial force transmission: a review and some new experimental results. Scand J Med Sci Sports 15:349–380CrossRef

28.

Cutlip RG, Baker BA, Hollander M, Ensey J (2009) Injury and adaptive mechanisms in skeletal muscle. J Electromyogr Kinesiol 19:358–372CrossRef

29.

Jarvinen TA, Jarvinen TL, Kaariainen M, Kalimo H, Jarvinen M (2005) Muscle injuries: biology and treatment. Am J Sports Med 33:745–764CrossRef

30.

Huard J, Lu A, Mu X, Guo P, Li Y (2016) Muscle injuries and repair: what’s new on the horizon! Cells Tissues Organs 202:227–236CrossRef

31.

Best TM, Gharaibeh B, Huard J (2013) Stem cells, angiogenesis and muscle healing: a potential role in massage therapies? Br J Sports Med 47:556–560CrossRef

32.

Riede U, Schmid MR, Romero J (2007) Conservative treatment of an acute compartment syndrome of the thigh. Arch Orthop Trauma Surg 127:269–275CrossRef

33.

Järvinen TAH, Järvinen TLN, Kääriäinen M, Kalimo H, Järvinen M (2005) Muscle injuries: biology and treatment. Am J Sports Med 33:745–764CrossRef

34.

Järvinen TA, Järvinen M, Kalimo H (2013) Regeneration of injured skeletal muscle after the injury. Muscles Ligaments Tendons J 3:337–345CrossRef

35.

Schmidt AH (2016) Acute compartment syndrome. Orthop Clin North Am 47:517–525CrossRef

36.

Prayson MJ, Chen JL, Hampers D, Vogt M, Fenwick J, Meredick R (2006) Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome. J Trauma 60:1037–1040CrossRef

37.

Egol KA, Bazzi J, McLaurin TM, Tejwani NC (2008) The effect of knee-spanning external fixation on compartment pressures in the leg. J Orthop Trauma 22:680–685CrossRef

Title: The association between intracompartmental pressure and skeletal muscle recovery after tibial diaphyseal fractures: an ambispective cohort study
Authors: Shengjie Tian
Shimin Chang
Yaogang Lu
Jianhua Zhu
Xuqiang Kong
Publication date: 01-12-2021
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2021
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1186/s10195-021-00579-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The association between intracompartmental pressure and skeletal muscle recovery after tibial diaphyseal fractures: an ambispective cohort study

Abstract

Background

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 1/2021

Pediatric elbow arthroscopy: clinical outcomes and complications after long-term follow-up

Increase in cartilage degeneration in all knee compartments after failed ACL reconstruction at 4 years of follow-up

Patient-reported results of simultaneous direct anterior approach and posterolateral approach total hip arthroplasties performed in the same patients

Early postoperative pain as a risk factor of shoulder stiffness after arthroscopic rotator cuff repair

Risk factors for refracture of the femoral shaft in children after removal of external fixation

Leg length discrepancy, overgrowth, and associated risk factors after a pediatric tibial shaft fracture