Well-leg compartment pressures during hemilithotomy position for fracture fixation

Objective: To evaluate the relationship between the well-leg compartment pr essures and time during hemilithotomy position for fracture fixation. Design: Prospective. Setting: Level 1 trauma center. Patients/Participants: Ten patients who underwent intramedullary nailing of a fractured femur in the hemilithotomy position (with a well-leg holder). Intervention: Continuous pressure monitoring was achieved with in-dwelling slit catheters inserted into the calf compartments of the well leg. Baselin e measurements were obtained in the supine position. After the leg was plac ed in the hemilithotomy position, compartment pressures were monitored thro ughout surgery. Main Outcome Measurements: Calf compartment pressures at baseline, during h emilithotomy position, and post-hemilithotomy were compared. The associatio n between body mass index and compartment pressure was analyzed. Results: A consistent pattern was observed between compartment pressures an d time. The curve was that of a step function in which the pressure increas ed as soon as the leg was placed in the well-leg holder and remained elevat ed until the leg was taken down. The pressure jumped from a baseline of 9.2 to 27.3 millimeters of mercury (mmHg) (p < 0.0001). While in the hemilitho tomy position, the leg pressure trended slightly upward. Once the leg was t aken down, the pressure immediately returned to a near-baseline level of 8. 1 mmHg (p < 0.0001). A significant correlation was also found between the b ody mass index and leg pressure (R-2 = 0.713; F = 0.002). Conclusions: The use of the well-leg holder to maintain hemilithotomy posit ion increases the calf compartment pressures dramatically and significantly . Therefore, we recommend avoiding this position for fracture fixation in a t-risk patients.