Faculty Collaboration Database

Open distal tibial shaft fractures: a retrospective comparison of medial plate versus nail fixation. Eur J Trauma Emerg Surg 2016 Feb;42(1):101-6

Date

06/04/2015

Pubmed ID

26038037

DOI

10.1007/s00068-015-0519-7

Scopus ID

2-s2.0-84958043312 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

PURPOSE: Studies comparing open reduction internal fixation (ORIF) vs. intramedullary nailing (IMN) for distal tibia shaft fractures focus upon closed injuries containing small patient series with open fractures. As such, complication rates for open fractures are unknown. To characterize complications associated with ORIF vs. IMN, we compared complications based on surgical approach in a large patient series of open distal tibia shaft fractures.

METHODS: Through retrospective analysis at an urban level I trauma center, 180 IMN and 36 ORIF patients with open distal tibia fractures from 2002 to 2012 were evaluated. Patient charts were reviewed to identify patient demographics, fracture grade (G), patient comorbidities, and postoperative complications including nonunion, malunion, infection, hardware-related pain, and wound dehiscence. Fisher's exact tests compared complications between ORIF and IMN groups. Multivariate regression identified risk factors with statistical significance for the development of a postoperative complication.

RESULTS: One hundred and eighty IMN (G1 22, G2 79, and G3 79) and 36 ORIF (G1 10, G2 16, and G3 10) patients were included for analysis. ORIF patients had a higher rate of nonunion (25.0 %, n = 9) compared with IMN patients (10.6 %, n = 20, p = 0.03). No additional complication had a significant statistical difference between groups. Multivariable analysis shows only surgical method influenced the development of complications: ORIF patients had 2.52 greater odds of developing complications compared with IMN patients (95 % CI 1.05-6.02; p = 0.04).

CONCLUSIONS: ORIF leads to higher rates of nonunion and significantly increases the odds of developing a complication compared with IMN for open distal tibia fractures. This is the first study investigating complication rates based on surgical approach in a large cohort of patients with exclusively open distal tibia fractures.

Author List

Avilucea FR, Sathiyakumar V, Greenberg SE, Ghiam M, Thakore RV, Francois E, Benvenuti MA, Siuta M, Smith AK, Ehrenfeld JM, Evans JM, Obremskey WT, Sethi MK

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Bone Nails
Bone Plates
Female
Fracture Fixation, Internal
Fracture Fixation, Intramedullary
Fractures, Malunited
Fractures, Open
Fractures, Ununited
Humans
Male
Middle Aged
Multivariate Analysis
Postoperative Complications
Regression Analysis
Retrospective Studies
Surgical Wound Dehiscence
Surgical Wound Infection
Tibial Fractures
Young Adult