Does Provisional Plating of Closed Tibia Fractures Have Higher Complication Rates?. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Haller, Justin M.; Githens, Michael; Scolaro, John; Firoozabadi, Reza
• Is Part Of: Journal of orthopaedic trauma. Volume 31:Issue 10(2017)
• Publication Date: 2017-10
• Subjects: intramedullary nail -- segmental tibia -- high-energy tibia fracture -- provisional fixation -- provisional plate -- tibia fracture; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000874
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: To compare infection and nonunion rates after provisional plating (PP) with standard reduction (SR) techniques for closed tibia fractures treated with an intramedullary nail. Design: Retrospective comparative study. Setting: Level 1 academic trauma center. Patients/Participants: Of the 348 closed tibia fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 42) treated using an intramedullary nail from January 2007 through June 2015, 231 (40 PP and 191 SR) patients met inclusion/exclusion criteria. Intervention: The patients received either a provisional plate or an SR before intramedullary nail placement. Main Outcome Measurement: Infection and nonunion. Results: The PP cohort had a significantly higher proportion of high-energy injury mechanism and a significantly higher proportion of diabetes than the SR cohort. We were unable to demonstrate a difference in rates of infection [PP cohort (1/40, 2.5%) vs. SR cohort (6/191, 3.1%), P = 1.0], nonunion [PP cohort (3/40, 7.5%) vs. SR cohort (9/191, 4.7%), P = 0.44], or malunion [PP cohort (0/40, 0%) vs. SR cohort (8/191, 4.2%), P = 0.36]. Symptomatic implant removal was similar between the 2 groups [PP cohort (4/40, 10%) vs. SR cohort (27/191, 14%), P = 0.61]. Conclusion: PP can be used for complex, closed tibia fractures without an increased risk of infection, nonunion, and malunion compared with standard closed reduction techniques. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.