Quantitation of skeletal-muscle necrosis in a model compartment syndrome
Hargens, A.R.; Schmidt, D.A.; Evans, K.L.; Gonsalves, M.R.; Cologne, J.B.; Garfin, S.R.; Mubarak, S.J.; Hagan, P.L.; Akeson, W.H.
Journal of Bone and Joint Surgery. American Volume 63(4): 631-636
1981
ISSN/ISBN: 0021-9355 PMID: 7217130 Document Number: 181647
Skeletal-muscle necrosis was evaluated in previously pressurized canine compartments using 99mTc stannous pyrophosphate and classic histological criteria. Intracompartmental necrosis was quantitated in the anterolateral muscle compartment of each dog by uptake of 99mTc stannous pyrophosphate using the contralateral anterolateral compartment as an internal control. Representative specimens of muscle were sampled in experimental and control legs of each dog and were analyzed by qualitative histological techniques. Muscle necrosis was assessed in compartments 48 h after pressurization to levels of 10-120 mm Hg for 8 h in 37 dogs. In another dog, neither anterolateral compartment was pressurized so that both compartments acted as control muscle. A threshold pressure level (30 mm Hg) and duration (8 h) were identified at which significant muscle necrosis occurs at normal blood pressure. A quantitative relationship apparently exists between incorporation of 99mTc stannous pyrophosphate and the level of intracompartmental pressure. This uptake technique is unsuitable for diagnosing compartment syndrome in patients with a threatened compartment syndrome. Intracompartmental pressure measurements by the wick-catheter technique, in conjunction with clinical findings, apparently offer the best means for diagnosing compartment syndrome.