Well-Leg Compartment Pressures During Hemilithotomy Position for Fracture Fixation

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Abstract
To evaluate the relationship between the well-leg compartment pressures and time during hemilithotomy position for fracture fixation. Prospective. Level 1 trauma center. Ten patients who underwent intramedullary nailing of a fractured femur in the hemilithotomy position (with a well-leg holder). Continuous pressure monitoring was achieved with in-dwelling slit catheters inserted into the calf compartments of the well leg. Baseline measurements were obtained in the supine position. After the leg was placed in the hemilithotomy position, compartment pressures were monitored throughout surgery. Calf compartment pressures at baseline, during hemilithotomy position, and post-hemilithotomy were compared. The association between body mass index and compartment pressure was analyzed. A consistent pattern was observed between compartment pressures and time. The curve was that of a step function in which the pressure increased as soon as the leg was placed in the well-leg holder and remained elevated 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 hemilithotomy position, the leg pressure trended slightly upward. Once the leg was taken 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 body mass index and leg pressure (R 2 = 0.713; F = 0.002). The use of the well-leg holder to maintain hemilithotomy position increases the calf compartment pressures dramatically and significantly. Therefore, we recommend avoiding this position for fracture fixation in at-risk patients.