Technology for the non-invasive surveilance of post-traumatic compartment syndrome

PROJECT SUMMARYAcute compartment syndromeACSremains one of the most devastating and often overlooked traumatic musculoskeletal disorders in clinical practiceIn this conditionpressure increases in one of the body s spacelimited compartmentsdue most commonly to direct trauma or bone fractureresulting ultimately in an ischemic injury to all of the compartment s contentsincluding muscle and nerveOnce a full blown compartment syndrome developsthe consequences are uniformly catastrophicwith permanent muscle and nerve losssometimes necessitating amputation of the entirely non functional limbIf caught before irrevocable damage is doneaggressive surgical decompressionvia fasciotomycan be performed to relieve the pressure in the compartment and allowing the muscles and nerves to recoverHowevercurrent approaches for assessing the development of ACSoutside of the physical examinationare limitedThe standard method involves the insertion of a pressure monitorThere are no effective approaches for the continuous surveillance for the development of ACS after an injuryOne technology that may be especially sensitive to the development of ACS is that of electrical impedance myographyEIMIn EIMa weakhigh frequency electrical current is passed between a number of electrodes overlying a muscle or muscle group of interest and the resulting surface voltages measured by a second set of electrodesThe health status of the underlying muscle impacts the measured voltages in consistent and predictable fashionFor instanceincreasing myofiber edema and injury would be expected to lead to reductions in the impedance resistance measureThe development of EIM for medical and broader health use is the underlying focus of MyolexInca small business concern based in San Francisco and BostonTo datethe technology has been shown to be effective in a wide variety of disorders that impact the muscle either directly or indirectlyincluding muscular dystrophyamyotrophic lateral sclerosisand sarcopeniamuscle wasting in the elderlyAdditional work has also suggested that EIM is sensitive to primary muscle injuryIn this study we propose to extend this workseeking to develop EIM as a non invasiveconvenient monitoring tool to assess the development of ACSThis will allow health care professionals to monitor compartments for ACS after predisposing injury intervene and to intervene at a sufficiently early pointso as to avoid permanent injuryIn our first specific aimwe will use a rat ACS model to assess changes in EIM values and the corresponding alterations in pathology at several severities of injury to establish a time course of change and the relationship to impedance valuesIn Specific Aimusing tissue data obtained in Aimand anatomic modelswe will design electrode arrays that will be most effective at detecting the development of ACS in a porcine model and in human subjects for use in our planned Phasestudies PROJECT NARRATIVEAcute compartment syndromeACSremains one of the most devastating and easily overlooked musculoskeletal disorders in clinical practiceIn this conditionpressure increases in one of the body s spacelimited compartmentsdue to trauma or bone fractureresulting ultimately in necrosis and death to all the compartment s contentsincluding muscle and nerveMyolexInc proposes to develop an electrical impedance based system for monitoring the development of compartment syndrome with initial testing in a rat model