A CADAVERIC AND RADIOLOGIC ASSESSMENT OF CATHETER PLACEMENT FOR THE MEASUREMENT OF FOREARM COMPARTMENT PRESSURES

The diagnosis of compartment syndrome is essentially a clinical one, I n recent years, much interest and research has focused on the developm ent of intracompartmental pressure monitoring devices to help in the d iagnosis of this condition, Proper placement of the catheter is essent ial for accurate monitoring, because an incorrect result is potentiall y more dangerous than no reading at all, In the forearm, measurement i n the flexor digitorum profundus is thought to be a more sensitive way of assessing rising pressure, One of the risks of catheter placement is inadvertent damage to a neurovascular structure, particularly when monitoring pressures in deeper muscle bellies, Standard anatomic texts and outpatient magnetic resonance scans of the forearm were studied t o define a safe pathway for the introduction of a catheter into the vo lar forearm, An approach from the midline to the ulna, between the ten dons of the flexor carpi radialis and palmaris longus, seemed the safe st, Ten cadaveric forearms had 100 cc of gastrograffin injected into t he deep forearm through a dorsal approach, The median and ulnar nerves were cannulated with a fine wire from the elbow to the wrist, Two can nulae were passed, using the suggested approach, at 2 locations betwee n the wrist and the mid forearm, All limbs then were scanned with comp uted tomography, and the images were reviewed, In all forearms, the ca nnulae passed between the median and ulnar nerves into the belly of th e flexor digitorum profundus and posed no risk to the neurovascular st ructures.