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Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial
PURPOSE: Impending compartment syndrome is a common event following closed tibia fractures, which can progress to sinister compartment syndrome. Fasciotomy is the only definitive treatment available, though it has its own drawbacks and complications. Medical management at present consists of limb el...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071718/ https://www.ncbi.nlm.nih.gov/pubmed/33288404 http://dx.doi.org/10.1016/j.cjtee.2020.11.006 |
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author | Nesaraj, Jerry Varghese, Viju Daniel Boopalan, P.R. Nithyananth, Manasseh Sudarsanam, Thambu David Jepegnanam, Thilak Samuel |
author_facet | Nesaraj, Jerry Varghese, Viju Daniel Boopalan, P.R. Nithyananth, Manasseh Sudarsanam, Thambu David Jepegnanam, Thilak Samuel |
author_sort | Nesaraj, Jerry |
collection | PubMed |
description | PURPOSE: Impending compartment syndrome is a common event following closed tibia fractures, which can progress to sinister compartment syndrome. Fasciotomy is the only definitive treatment available, though it has its own drawbacks and complications. Medical management at present consists of limb elevation and adequate hydration. This study aims at determining whether intravenous administration of Mannitol reduced the intracompartmental pressure in patients with closed tibial fractures. METHODS: This is a double blinded, randomized control trial done in a single tertiary care center in India. Forty-five patients were recruited between February 2012 and October 2012. Forty patients who presented to the emergency department with isolated, closed, high velocity, and proximal 2/3 tibia fractures were included in this study. Patients with contraindication to Mannitol were excluded. They were allocated into 2 groups by the investigator using computer generated randomization. The pressure in the anterior compartment of the leg was measured with a handheld Stryker pressure monitor. Then either 20% Mannitol or 0.9% normal saline as given intravenously in a blinded manner, based on the randomization. The intracompartmental pressure was measured at 0, 1 and 3 h after the infusion. The participant, investigator and statistician were masked to the group assessment. RESULTS: There was no difference in intracompartmental pressures at 1 or 3 h, between the groups. However, in patients with the baseline of compartmental pressures ≥30 mmHg, Mannitol showed a marked reduction in pressure of 8.5 mmHg at 1 h compared to almost no change in pressure in the saline group. There were no adverse events with the use of Mannitol. CONCLUSIONS: This preliminary study appears to show that Mannitol is useful in the management of the increased compartment pressure. The limitations of this study were that it only involved a small group of patients and the baseline pressures in both the groups were not comparable. More studies are required before the use of Mannitol as a standard of care in the management of compartment syndrome can be established. |
format | Online Article Text |
id | pubmed-8071718 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-80717182021-04-27 Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial Nesaraj, Jerry Varghese, Viju Daniel Boopalan, P.R. Nithyananth, Manasseh Sudarsanam, Thambu David Jepegnanam, Thilak Samuel Chin J Traumatol Original Article PURPOSE: Impending compartment syndrome is a common event following closed tibia fractures, which can progress to sinister compartment syndrome. Fasciotomy is the only definitive treatment available, though it has its own drawbacks and complications. Medical management at present consists of limb elevation and adequate hydration. This study aims at determining whether intravenous administration of Mannitol reduced the intracompartmental pressure in patients with closed tibial fractures. METHODS: This is a double blinded, randomized control trial done in a single tertiary care center in India. Forty-five patients were recruited between February 2012 and October 2012. Forty patients who presented to the emergency department with isolated, closed, high velocity, and proximal 2/3 tibia fractures were included in this study. Patients with contraindication to Mannitol were excluded. They were allocated into 2 groups by the investigator using computer generated randomization. The pressure in the anterior compartment of the leg was measured with a handheld Stryker pressure monitor. Then either 20% Mannitol or 0.9% normal saline as given intravenously in a blinded manner, based on the randomization. The intracompartmental pressure was measured at 0, 1 and 3 h after the infusion. The participant, investigator and statistician were masked to the group assessment. RESULTS: There was no difference in intracompartmental pressures at 1 or 3 h, between the groups. However, in patients with the baseline of compartmental pressures ≥30 mmHg, Mannitol showed a marked reduction in pressure of 8.5 mmHg at 1 h compared to almost no change in pressure in the saline group. There were no adverse events with the use of Mannitol. CONCLUSIONS: This preliminary study appears to show that Mannitol is useful in the management of the increased compartment pressure. The limitations of this study were that it only involved a small group of patients and the baseline pressures in both the groups were not comparable. More studies are required before the use of Mannitol as a standard of care in the management of compartment syndrome can be established. Elsevier 2021-03 2020-11-20 /pmc/articles/PMC8071718/ /pubmed/33288404 http://dx.doi.org/10.1016/j.cjtee.2020.11.006 Text en © 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Nesaraj, Jerry Varghese, Viju Daniel Boopalan, P.R. Nithyananth, Manasseh Sudarsanam, Thambu David Jepegnanam, Thilak Samuel Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial |
title | Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial |
title_full | Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial |
title_fullStr | Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial |
title_full_unstemmed | Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial |
title_short | Intravenous Mannitol reduces intracompartmental pressure following tibia fractures: A randomized controlled trial |
title_sort | intravenous mannitol reduces intracompartmental pressure following tibia fractures: a randomized controlled trial |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071718/ https://www.ncbi.nlm.nih.gov/pubmed/33288404 http://dx.doi.org/10.1016/j.cjtee.2020.11.006 |
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