Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Metcalf, Kathryn B.; Smith, Eric J.; Wetzel, Robert J.; Sontich, John K.; Ochenjele, George
• Is Part Of: Journal of orthopaedic trauma. Volume 34:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: tibia -- fracture -- gunshot wound -- infection -- nonunion; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000001709
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objective: To assess the outcomes of patients who sustained blunt trauma tibia fractures compared with tibia fractures from civilian gunshot injuries when treated with intramedullary fixation. Design: Retrospective chart review. Setting: Level I trauma center. Patients/Participants: Two hundred and seven patients underwent intramedullary nailing for 211 tibia fractures. Methods: A retrospective review of tibia fracture(s) treated with intramedullary fixation with comparison of closed, open, and gunshot wound (GSW) fracture outcomes. Main Outcome Measurements: Outcomes included infection and nonunion. Results: The infection rate in closed and GSW tibia fractures was significantly lower compared with the infection rate of open fractures (1% vs. 9% vs. 20%; P = 0.00005). Significantly lower rates of nonunion in closed fractures compared with open fractures and GSW fractures were appreciated (8% vs. 20% vs. 30%; P = 0.003). There was no difference in infection or nonunion between GSW fractures with small wounds, no exposed bone, and minimal comminution and closed injuries ( P = 0.24, P = 0.60). Conversely, there was a significantly higher nonunion rate in GSW fractures with large wounds, exposed tibia, and comminution compared with blunt injuries ( P = 0.0014). Conclusions: This study suggests that tibia fractures from civilian GSWs are heterogeneous injuries, and outcomes are dependent on the extent of soft-tissue injury, bone exposure, and bone loss. There are comparable infection rates in all fractures due to civilian GSWs and closed fractures, which are lower than high-grade open fractures. Tibia GSW fractures with exposed bone and comminution have higher complication rates and should be treated accordingly. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.