Well-leg compartment pressures during hemilithotomy position for fracture fixation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• The hemilithotomy position, often utilized for femur fracture fixation, employs a well-leg holder.
• Potential risks associated with prolonged extremity elevation and pressure warrant investigation.

Purpose of the Study:

• To assess the impact of the hemilithotomy position on well-leg compartment pressures.
• To determine the relationship between compartment pressures and surgical duration in this position.

Main Methods:

• Prospective study involving ten patients undergoing femur fracture intramedullary nailing in hemilithotomy.
• Continuous calf compartment pressure monitoring using in-dwelling slit catheters.
• Comparison of pressures in supine, hemilithotomy, and post-procedure positions; correlation with BMI.

Main Results:

• Compartment pressures significantly increased from baseline (9.2 mm Hg) to 27.3 mm Hg upon leg elevation (p<0.0001).
• Pressures remained elevated throughout the procedure and returned to near-baseline (8.1 mm Hg) after repositioning (p<0.0001).
• A significant correlation was observed between higher body mass index and elevated compartment pressures (R2 = 0.713).

Conclusions:

• The well-leg holder in hemilithotomy position causes a dramatic and significant increase in calf compartment pressures.
• This positional change poses a risk for compartment syndrome, particularly in patients with higher BMI.
• Avoidance of the hemilithotomy position with a well-leg holder is recommended for fracture fixation in at-risk patients.