• Darryl A Auston, Jordan Meiss, Rafael Serrano, Thomas Sellers, Gregory Carlson, Timothy Hoggard, Michael Beebe, Jonathan Quade, David Watson, Robert Bruce Simpson, Brian Kistler, Anjan Shah, Roy Sanders, and Hassan R Mir.
• *Florida Orthopaedic Institute, Orthopaedic Trauma Service, Tampa General Hospital, Tampa, FL; †Upstate Orthopedics, Syracuse, NY; ‡University of South Florida School of Medicine, Tampa, FL; and §Hughston Trauma, Fort Walton Beach, FL.
• J Orthop Trauma. 2017 Apr 1; 31 (4): 215-219.

ObjectiveTo compare the incidence of complications (wound, infection, and nonunion) among those patients treated with closed, percutaneous, and open intramedullary nailing for closed tibial shaft fractures.DesignRetrospective review.SettingMultiple trauma centers.PatientsSkeletally mature patients with closed tibia fractures amenable to treatment with an intramedullary device.InterventionIntramedullary fixation with closed, percutaneous, or open reduction.Main Outcome MeasurementsSuperficial wound complication, deep infection, nonunion.ResultsA total of 317 tibial shaft fractures in 315 patients were included in the study. Two-hundred fractures in 198 patients were treated with closed reduction, 61 fractures in 61 patients were treated with percutaneous reduction, and 56 fractures in 56 patients were treated with formal open reduction. The superficial wound complication rate was 1% (2/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 3.6% (2/56) for the open group with no statistical difference between the groups (P = 0.179). The deep infection rate was 2% (4/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 7.1% (4/56) for the open group with no significant difference between the groups (P = 0.133). Nonunion rate was 5.0% (10/200) for the closed group, 4.9% (3/61) for the percutaneous group, and 7.1% (4/56) for the open group, with no statistical difference between the groups (P = 0.492).ConclusionsThis is the largest reported series of closed tibial shaft fractures nailed with percutaneous and open reduction. Percutaneous or open reduction did not result in increased wound complications, infection, or nonunion rates. Carefully performed percutaneous or open approaches can be safely used in obtaining reduction of difficult tibial shaft fractures treated with intramedullary devices.Level Of EvidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

35 keywords...

hide…