Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2016

01-02-2016 | Original Article

Open distal tibial shaft fractures: a retrospective comparison of medial plate versus nail fixation

Authors: F. R. Avilucea, V. Sathiyakumar, S. E. Greenberg, M. Ghiam, R. V. Thakore, E. Francois, M. A. Benvenuti, M. Siuta, A. K. Smith, J. M. Ehrenfeld, J. M. Evans, W. T. Obremskey, M. K. Sethi

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2016

Login to get access

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.
Literature
1.
Im G-I, Tae S-K. Distal metaphyseal fractures of the tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005;59:1219–23.CrossRefPubMed
2.
Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail. A retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31:709–11.PubMedCentralCrossRefPubMed
3.
Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011;25(12):736–41.CrossRefPubMed
4.
Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008;22(5):307–11.CrossRefPubMed
5.
Yang SW, Tzeng HM, Chou YJ, et al. Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 2006;37(6):531–5.CrossRefPubMed
6.
Lee YS, Chen SH, Lin JC, et al. Surgical treatment of distal tibia fractures: a comparison of medial and lateral plating. Orthopedics. 2009;32(3):163.CrossRefPubMed
7.
Fong K, Truong V, Foote CJ, et al. Predictors of nonunion and reoperation inpatients with fractures of the tibia: an observational study. BMC Musculoskel Dis. 2013;14:103.CrossRef
8.
Antonova E, Le TK, Burge R, et al. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskel Dis. 2013;14:42.CrossRef
9.
Harris I, Lyons M. Reoperation rate in diaphyseal tibia fractures. ANZ J Surg. 2005;75(12):1041–4.CrossRefPubMed
10.
Obremskey WT, Medina M. Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists. Orthopedics. 2004;27(11):1180–4.PubMed
11.
Robinson CM, McLaughlan GJ, Mclean IP, et al. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. J Bone Joint Surg Br. 1995;77B:781–7.
12.
Court-Brown CM, Will E, Christie J, et al. Reamed or undreamed nailing for closed tibial fractures: a prospective study in Tscherne C1 fractures. J Bone Joint Surg. 1996;78B:580–3.
13.
Dogra AS, Ruiz AL, Thompson NS, et al. Dia-metaphyseal distal tibia fractures—treatment with a shortened intramedullary nail: a review of 15 cases. Injury. 2000;31:799–804.CrossRefPubMed
14.
Iqbal HJ, Pidikiti P. Treatment of distal tibia metaphyseal fractures: plating versus intramedullary nailing: a systematic review of recent evidence. Foot Ankle Surg. 2013;19(3):143–7.CrossRefPubMed
15.
Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36–40.PubMed
16.
Bhandari M, Guyatt GH, Swiontkowski MF et al. Surgeons’ preferences for the operative treatment of fractures of the tibial shaft: an international survey. J Bone Joint Surg Am. 2001; 83(11):1746–52.
17.
Antonova E, Le TK, Burge R, et al. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskel Dis. 2013;14:42.CrossRef
18.
Guo JJ, Tang N, Yang HL, et al. A prospective, randomized trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92-B(7):984–8.CrossRef
19.
Nork SE, Schwartz AK, Agel J, et al. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87:1213–21.CrossRefPubMed
20.
Lack WD, Karunakar MA, Angerame MR, et al. Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. J Orth Trauma. 2015;29(1):1–6.CrossRef
Metadata
Title
Open distal tibial shaft fractures: a retrospective comparison of medial plate versus nail fixation
Authors
F. R. Avilucea
V. Sathiyakumar
S. E. Greenberg
M. Ghiam
R. V. Thakore
E. Francois
M. A. Benvenuti
M. Siuta
A. K. Smith
J. M. Ehrenfeld
J. M. Evans
W. T. Obremskey
M. K. Sethi
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0519-7

Other articles of this Issue 1/2016

European Journal of Trauma and Emergency Surgery 1/2016 Go to the issue

Editorial

Focus on wrist injuries

Original Article

Nine-year change of mortality and discharge against medical advice among major trauma patients in a Chinese Intensive Care Unit

Original Article

13-Year experience in external fixation of the pelvis: complications, reduction and removal

Review Article

Wrist motion analysis in scaphoid nonunion

Review Article

Uncommon carpal fractures

Review Article

Management algorithm for index through small finger carpometacarpal fracture dislocations