Introduction: The role of continuous compartment pressure monitoring to detect compartment syndrome associated with tibia fractures is unclear. Our study aims to assess the impact of continuous compartment pressure monitoring in patients with acute tibial fractures.

Method: A randomised controlled trial was performed on 200 consecutive extra-articular tibial shaft fractures presenting to a major metropolitan trauma centre between June 2000 and August 2003. One hundred patients were randomised to continuous compartment pressure monitoring of the anterior compartment for 36 hours. The other group received usual care. The surgical team was alerted if the compartment pressure was within 30mmHg of the diastolic blood pressure. Compartment syndrome was diagnosed on clinical grounds in alert patients. All cases of compartment syndrome were treated with fasciotomy. All patients were followed-up for a minimum of six months.

Result: During the study period, three patients presented with acute compartment syndrome and underwent immediate fasciotomy and, consequently, were not entered into the study. In several cases, monitoring revealed pressures within 30 mmHg of diastolic blood pressure, but compartment syndrome was excluded on clinical grounds. The two groups were comparable with regards to age, mechanism of injury and fracture classification. Of the 100 control fractures, there were three cases of compartment syndrome. Each underwent fasciotomy without significant sequelae. Of the 100 monitored fractures, no cases of compartment syndrome were diagnosed. There were no cases of missed compartment syndrome in this study. Continuous compartment pressure monitoring requires regular nurse education and, despite this, in most patients monitoring was not complete.

Conclusion: We did not find continuous compartment pressure monitoring useful in diagnosing compartment syndrome in patients with acute tibial fractures or preventing missed compartment syndrome. However, this study is underpowered to detect differences in missed compartment syndrome and it may be subject to trial bias as the level of awareness of compartment syndrome was raised by performing the trial. We no longer perform continuous compartment pressure monitoring at our institution.

Introduction There is a perception in the orthopaedic community that patients with workers’ compensation claims have a poorer outcome than non-compensation patients. This review aims to identify and quantify the effect of workers’ compensation claims on the outcome of orthopaedic treatment.

Methods A systematic review of the literature was performed. Studies of any language published between 1966 and 2002 that compared the outcomes of compensation against a non-compensation group for any orthopaedic treatment were included. Articles with any group less than 20 patients were excluded. Literature searching and data extraction were performed independently by both reviewers and then compared. Differences between reviewers’ findings were resolved by discussion. Measures of region specific objective outcome, where available, were pooled into satisfactory and unsatisfactory groups for comparison. The raw data was used for a meta-analysis. The total number of articles that met the search criteria was 63. Within these articles there were 7,279 patients with workers’ compensation claim and 14,368 patients with no compensation claim.

Results No articles found that the workers’ compensation group had better outcomes. Fourteen found no difference between the two groups while 49 articles described a worse outcome in the compensation group. In the 41 papers which had outcome scores available for comparison there were 3,608 compensation patients with outcome scores and the outcome was unsatisfactory in 33.7%. There were 6,607 non-compensation patients with outcome scores and the outcome was unsatisfactory in 15.1% of non-compensation patients. The difference was significant (p< 0.01). The Relative Risk (RR) of an unsatisfactory outcome in workers’ compensation patients is 2.2. The Attributable Risk (AR), which gives the percentage of poor outcomes in the compensation group directly attributable to their compensation status, was 55.1%. Subgroup analysis of the major groups (spine: n=7,815, carpal tunnel: n=743, and shoulder n=379) revealed similar findings for each group (spine: RR=2.1, carpal tunnel: RR=2.2, shoulder: RR=5.1).

Conclusions From reviewing the literature, workers’ compensation patients have a poorer outcome compared to non-compensation patients for the same orthopaedic conditions. A workers’ compensation patient has more than double the risk of having a poor outcome in comparison to the non-compensation patient. More than half of the poor results in the compensation group can be attributed to their compensation status.