Compartment Divisions of the Hand Revisited: Rethinking the Validity of Cadaver Infusion Experiments

Author(s): Guyton GP, Sheraman CM, Saltzman CL

Source: J Bone Joint Surg

Summary:

The original experiments defining the fascial anatomy of the hand involved the injection of Renograffin and green dye into each dorsal interosseous muscle. Dissection revealed containment of the dye within the dorsal compartment without extravasations into the volar interossei. This lead to the conclusion that the hand consisted of ten individual compartments and that surgical fasciotomy required release of each compartment. This study reevaluated this concept using a more sophisticated technique. Real-time CT was used to monitor the spread of contrast medium during injection, and pressure measurements were recording throughout the process. Four cadaver hands underwent the procedure with injection performed within the second dorsal interosseous muscle belly. In all hands, contrast medium was observed within the first and second volar interossei before the pressure reached 15 mm Hg within the second dorsal compartment.

This article questions principles of surgical fasciotomy for compartment syndrome of the hand. The muscles may exist as physiologically separate entities under low pressures without the adverse consequences of trauma and swelling. However, the tissue separating the dorsal and volar interossei appears rather tenuous and becomes incompetent as the pressure within the dorsal compartment rises toward 15 mm Hg. The clinical significance of this cadaver model is that release of the volar compartments may not be required during hand fasciotomy. Clinical observations or investigations may be required prior to the acceptance of these findings into practice.

Link:

 Journal of Bone and Joint Surgery