Needle placement in foot compartment pressure monitoring: a cadaveric study

J. Giddie, M. Dunn, L. David, G. Smith

Introduction: Subfascial pressure measurement forms an integral part of compartment syndrome diagnosis. As the clinical signs are less reliable in foot compartment syndrome (FCS) there is a greater emphasis on invasive catheterization. A previous study noted the location of foot compartments on an MRI 3-Dimesional generated virtual foot model. A guide for needle placement was generated for accurate needle insertion for pressure monitoring. To date this instructional guide has not been assessed on cadaveric specimens.

Aims: 1. Assess accuracy of needle placement within cadaveric feet without knowledge of instructional guide. 2. Identify if the needle placement is reproducible and accurate in cadaveric feet after reading the guide.

Materials & Methods: The 3 participants were asked to place stryker gauge monitor needles into 9 individual compartments of a cadaveric foot. To limit bias each participant was assessed separately on an untouched cadaveric foot. Each compartment was assigned a different coloured gelatin dye, which was injected via the needles placed. The feet were then dissected by the lead author, findings recorded and pictures taken to be presented. The second part of the study involved educating the 3 participants of the anatomical location and depth of each compartment and the exercise repeated.

Results: Success of identifying correct anatomical compartment pre and post education - Foot and ankle consultant - (5/9) 56%; (9/9) 100%, Orthopaedic Registrar - (3/9) 33%; (7/9) 78%, Upper limb consultant - 2/9 (22%); 7/9 (78%).

Conclusion: We can confirm the previously generated instructional guide which utilises landmarks for needle insertion are accurate and reproducible in cadaveric feet specimens. Prior to education needle placement resulted in successful penetration of the correct compartment in only 37% of attempts. This emphasizes the importance of only relying on compartment pressure monitoring in cases of FCS when an appropriately trained individual has inserted the needles.