Messung des Gewebedruckes in den Muskellogen (Kompartments) der Extremitäten des Hundes

Abstract

This study gives a survey of the literature about compartmental syndromes in man and dogs. In anatomical preliminary studies the known osteofascial compartments at the femur, the crus and the antebrachium of the dog were dissected. Three standard positions for pressure measurement (proximal, middle and distal third) in the cranial and caudal femoral, the craniolateral tibial and the caudomedial antebrachial compartment were chosen. By injecting coloured dye at these positions the correct placement in each compartment could be verified in the anatomic dissection.

In a clinical study of half year duration 40 dogs with fractures of the femur (n=15), the tibia (n=15) or the antebrachium (n=11) were investigated by measuring intracompartmental pressures with a digital monitoring device (MEREX).

Measurements were token under general anesthesia at the contralateral sound extremity (n=41), the fractured limb preoperatively (n=39), postoperatively (n=37), the first day (n=13) and the second day (n=2) after surgical management of the fractures.

No uniform intracompartmental pressure for the dog could be found. Comparison between regions showed that the craniolateral tibial compartment had higher normal values (5,9 ± 3,0 mm Hg) than the cranial (3,5 ± 2,1 mm Hg) and caudal (2,5 ± 1,2 mm Hg) femoral compartment and the caudomedial compartment of the antebrachium (2,6 ± 1,2 mm Hg).

Fractures increased the intracompartmental pressure in most cases. In the tibial compartment average pressure elevations were more severe (5,5 mm Hg) than in the compartments of the antebrachium (3,3 mm Hg) and the thigh (2 mm Hg).

After osteosynthesis the increase of the pressure in the compartments of the thigh was only mild, in the tibial compartment, however, the pressure was markedly elevated. In the antebrachial compartment postoperative pressure elevations were only found after tight subcutaneous suturing.

Four patients with oblique tibial fractures showed severe pre- and postoperative pressure rises (> 20 mm Hg). One dog with a transverse tibial fracture and three dogs with complex radius/ulna fractures showed similar postoperative pressure elevations.

Despite developement of rather high differences between pressures in the sound and the fractured extremity (pre- and postoperatively) critical netto values were hardly reached.

Pressure values indicating an impending or manifest compartmental syndrome in human medicine only appeared in few cases. These dogs however, developed no remaining functional defects.

The findings of the current study have the following clinical relevance: Intracompartmental pressure elevations in fractured limbs are usually mild. In cases suspicious for having developed higher pressures or in risk patients (with dog bite wounds or oblique tibial fractures) a tight fascial closure should be avoided. Only in these patients postoperative pressure measurements are indicated to assess the need of performing a fasciotomy. Longer lasting pressure elevations exceeding 40 mm Hg require surgical decompression of the compartment.