Is compartment monitoring indicated in patients with an altered GCS and a closed long bone fracture?
Date First Published:
August 12, 2010
Last Updated:
September 14, 2010
Report by:
Nawfal Al-Hadithy, SHO in Orthopaedics (Barnet and Chase Farm Hospital)
Search checked by:
Shafic Al-Nammari, Barnet and Chase Farm Hospital
Three-Part Question:
After sustaining a [closed tibial fracture in a patient with an altered GCS], should [compartment monitoring be performed], to [prevent the development of compartment syndrome]?
Clinical Scenario:
A 35 year old man presents to A+E having been involved in high speed car accident. He is brought in haemodynamically stable with a CT negative closed head injury- GCS 6/15 and bilateral tibial shaft fractures. You wonder if compartment pressure monitoring of his lower limbs is indicated.
Search Strategy:
OVID interface on the world wide web. 1966 – August 2010
[({compartment syndrome OR compartment pressure.mp} AND {monitor$ OR measure$ OR evaluat$.mp}]
LIMIT to English AND Randomised Controlled Trial
[({compartment syndrome OR compartment pressure.mp} AND {monitor$ OR measure$ OR evaluat$.mp}]
LIMIT to English AND Randomised Controlled Trial
Outcome:
2 papers found of which both were irrelevant or of insufficient quality for inclusion.
Author Commentary:
There are no randomised controlled trials in the literature to support compartment pressure monitoring in patients who have closed long bone fractures and altered GCS.<br><br>Despite this most Orthopaedic surgeons would advocate this as clinical examination of an unconscious patient for compartment syndrome is notoriously unreliable.
Bottom Line:
There is no evidence to determine whether all patients with impaired GCS and a closed tibial fracture should undergo compartment pressure monitoring to prevent compartment syndrome. Local advice should be followed.