Continuous compartment pressure monitoring for tibia fractures: does it influence outcome?

BACKGROUND: Compartment syndrome is common in acute fractures of the tibia. Early diagnosis is important, as delayed treatment leads to significant complications. Continuous compartment pressure monitoring has been recommended to prevent late diagnosis of compartment syndrome associated with tibia fractures. In this study, we aim to examine the effect of continuous compartment pressure monitoring on outcome in acute tibia fractures. METHODS: We randomized 200 consecutive acute extra-articular tibia fractures into monitored and nonmonitored groups. The monitored group received continuous compartment pressure for 36 hours and the nonmonitored group received usual postoperative observations. In alert patients, the diagnosis of compartment syndrome was made clinically. In unconscious patients, a difference between compartment pressure and diastolic blood pressure (DeltaP) of less than 30 mm Hg was the criteria for fasciotomy. Patients were assessed for late sequelae of compartment syndrome (sensory loss, muscle weakness, contracture, and toe clawing) at 6 months. RESULTS: Eighty-nine percent of patients were followed up for a minimum of 6 months or to fracture union. There were five cases of compartment syndrome in the nonmonitored group and none in the monitored group. At 6 months, the complication rates and late sequelae in both groups were not significantly different. In the monitored group, there were 18 patients with DeltaP less than 30 mm Hg, none of whom developed compartment syndrome or late sequelae. In both groups, patients with high energy or open fractures had significantly more late sequelae. CONCLUSIONS: Continuous compartment pressure monitoring is not indicated in alert patients who are adequately observed.

Publication bias in papers presented to the Australian Orthopaedic Association Annual Scientific Meeting.

BACKGROUND: The selective publication of articles based on factors, such as positive outcome, statistical significance and study size is known as publication bias. If publication bias is present, any clinical decision based on a review of the published work will also be biased. Publication bias has been shown in various specialties, based on review of publication rates for abstracts presented at major scientific meetings. This study was conducted to investigate publication bias in orthopaedics. METHODS: Abstracts presented at the 1998 Australian Orthopaedic Association Annual Scientific Meeting were reviewed independently by two reviewers. Details of sample size, study setting, country of origin, outcome and study type were recorded for each abstract. Publication within 5 years was ascertained by electronic searching of Medline and Embase databases and direct author contact. Logistic regression analysis was used to identify predictors of publication. RESULTS: The overall publication rate was 31%. Publication was more likely if the study was a laboratory study, rather than a clinical study (odds ratio (OR), 3.45; 95% confidence interval (CI) 1.69-7.01, P < 0.001). Sample size, country of origin, study type, statistical significance and positive outcome were not significantly associated with publication. CONCLUSION: According to this study, laboratory studies were significantly more likely to be published than clinical studies. In contrast to previous studies, publication bias due to the selective publication of papers with a positive outcome or those reporting statistical significance was not found.