Is compartment monitoring indicated in patients with an altered GCS and a closed long bone fracture?

Report By: Nawfal Al-Hadithy - SHO in Orthopaedics
Search checked by Shafic Al-Nammari - Registrar in Orthopaedics
Institution: Barnet and Chase Farm Hospital
Date Submitted: 12th August 2010
Last Modified: 14th September 2010
Status: Blue (submitted but not checked)

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

Search Outcome

2 papers found of which both were irrelevant or of insufficient quality for inclusion.

Comment(s)

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.

Despite this most Orthopaedic surgeons would advocate this as clinical examination of an unconscious patient for compartment syndrome is notoriously unreliable.

Clinical 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.