Ultrasound Elastography for Compartment Syndrome Evaluations
Abstract
Rational and Objectives: Extremity injuries are the most common problems on the battlefield. Following limb injuries, acute compartment syndrome (ACS) can occur due to increased muscle volume by swelling or bleeding. If the swollen muscles are within a tied compartment, the intra compartment pressure (ICP) will increase. When the ICP reaches a certain level (over 30mmHg), blood supply to the muscles will be cut and will lead muscle death. Thus, early clinical diagnosis of ACS and treatment decision for fasciotomy is crucial to avoid major complications. Clinical signs and examinations are important for the ACS diagnosis. The ICP is a reliable measure to assess the severity of the ACS and guide the surgeons to make a right decision at the right time for fasciotomy, which is an effective way to release the ICP. However, the clinical standard ICP measurement is using a large needle inserted into the muscle compartment, which is a painful and invasive procedure, especially if the ICP needs to be frequently measured or even continuously monitored. Thus, a noninvasive and reliable alternative methodology to measure the ICP is desired. Recently, we have developed a noninvasive technology using ultrasound shear wave elastography (SWE) to measure the ICP. Our preliminary results are promising and encouraging. Therefore, the overall goal of this project is to further refine and validate this novel technology using our newly developed turkey animal model. Two objectives are proposed in this application. One is to verify and validate whether the muscle shear modulus measured by ultrasound elastography will be correlated to the true muscle compartment pressure using a turkey lower extremity compartment syndrome model in the early phase; and the second is to define whether the ultrasound shear wave elastography can be used to measure muscle mechanical properties (Young’s modulus), which will be correlated with the muscle functional and structural changes following ACS using the turkey ACS model. Applicability: Ultrasound is a common technology used in clinical examination for various fields, including orthopaedics. This technology is noninvasive, uses no radiation, a fast examination, and low cost. Recently, few companies have developed the ultrasound machine with the elastographic capacity including wave excitation and analytic software, which makes the SWE examination much easier than before. If we can successfully verify that SWE could be used as a surrogate to measure the muscle pressure at the early stage and assess the muscle properties at the late stage of the acute compartment syndrome, we will have provided a clinically useful tool for the decision making of surgical treatment and the ACS prediction. The ultrasound machine, with SWE capacity, is inexpensive and portable and can be used in any clinic, including using it on the battlefield. The operation of SWE examination is also relatively straightforward after a short period of training. Therefore, this technology will have an excellent applicability if the proof of concept is established by this proposal. Military Benefit: Extremity injury is the most common battlefield causality often caused by fragmentation injury from explosions in Afghanistan and the Iraq war. Explosions can leads to soft tissue trauma, fracture, and vascular ruptures, which place extremities at a high risk for acute compartment syndrome. ACS is a devastating complication followed by extremity injury that often leads to loss of muscle function and long-term productivity. Fasciotomy defined as opening compartment to release pressure is effective, but frequently delayed due to difficulties of ACS diagnosis and surgical decision making. A large cohort of clinical combat-field study (336 cases) has demonstrated that delayed fasciotomy resulted in a higher rate of muscle loss, amputation, and mortality. In this study, two groups of patients were evaluated: (1) fasciotomy performed
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010752
Entities
People
- Chunfeng Zhao
Organizations
- Mayo Clinic
- United States Army