Quantification of intracompartmental pressure and volume under plaster casts

Area of Science:

• Orthopedics
• Surgical Research
• Biomedical Engineering

Background:

• Compartment syndrome is a serious condition characterized by elevated intracompartmental pressure.
• Casts are often used in orthopedic treatment but can potentially exacerbate or cause compartment syndrome.
• Accurate monitoring of intracompartmental pressure is vital for diagnosing and managing this condition.

Purpose of the Study:

• To investigate the effects of padded plaster casts on hind-limb muscle compartment pressure and volume in dogs.
• To evaluate the impact of cast modification (splitting and cutting padding) on reducing intracompartmental pressure.
• To assess residual intracompartmental pressure after cast removal.

Main Methods:

• Infusion lines and wick catheters were inserted into hind-limb muscle compartments of 26 dogs.
• Padded plaster casts were applied, and intracompartmental pressure and volume were measured.
• Three types of padding were tested: dry Webril, Webril soaked in blood and povidone-iodine, and dried Webril soaked in blood and povidone-iodine.
• The effects of splitting the cast and cutting the padding on pressure were determined.

Main Results:

• The applied cast restricted compartment volume expansion by approximately 40%.
• Splitting and spreading the cast resulted in a mean intracompartmental pressure reduction of 65%.
• Cutting the Webril padding led to an additional 10-20% pressure reduction.
• Residual elevation of intracompartmental pressure was observed in all limbs even after cast removal.

Conclusions:

• Casts significantly restrict compartment volume and can elevate intracompartmental pressure.
• Surgical intervention, such as cutting the cast and padding, effectively reduces intracompartmental pressure.
• Continuous clinical monitoring is essential for patients with suspected compartment syndrome, even after cast removal, due to potential residual pressure elevations.