Rates and timing of short-term complications following operative treatment of tibial shaft fractures

Abstract

Introduction: Tibial shaft fractures are a relatively common injury in orthopaedic surgery, with management options including intramedullary nail (IMN) fixation or open reduction internal fixation (ORIF) with plate osteosynthesis. Using a large national database, we sought to compare the prevalence and timing of short-term complications following either IMN or ORIF for tibial shaft fractures.Methods: The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients undergoing IMN or ORIF for the treatment of tibial shaft fracture between 2012 and 2018. Multivariate Poisson hurdle regression models were utilized to determine predictors of postoperative complications as well as the timing of postoperative complications.Results: A total of 4963 tibial shaft fracture were identified, with 3601 patients undergoing IMN (72.6%) and 1362 undergoing ORIF (27.4%). Patients undergoing IMN had a lower mean age of 48.8 compared with 53.9 for plate osteosynthesis (P < .001). IMN patients were also more likely to be male (53.5%) compared with ORIF patients (44.2%, P < .001). In multivariate analysis, ORIF patients were significantly more likely to experience surgical site complications, including dehiscence, superficial, and deep infections (OR 2.04, P = .003). There was no difference in probability of VTE between constructs; however, patients who underwent ORIF were diagnosed with VTE earlier than those who underwent IMN (relative rate 0.50, P < .001). There was no difference between ORIF and IMN with regard to probability or timing of subsequent blood transfusion, major complications, or return to the operating room. Many patient factors, such as higher American Society of Anesthesiologists score, congestive heart failure, and hypertension, were independently associated with an increased risk of postoperative complications.Conclusions: Postoperative complications within 30 days are common after the surgical treatment of tibial shaft fractures. The risk of developing specific complications and the timing of these complications vary depending on numerous factors, including potentially modifiable risk factors such as the method of fixation or operative time, as well as nonmodifiable risk factors such as medical comorbidities.

Patient Comorbidities Associated With Acute Infection After Open Tibial Fractures

“… 3 Another study of 4,963 tibial shaft fractures showed an overall infection rate of 0.02% within 30 days of ORIF/IMN but different rates of infection between open and closed fractures were not reported. 19 In that same study though, a higher American Society of Anesthesiologists score, congestive heart failure, and hypertension were associated with acute infection. 19 In 480 patients with tibial shaft fractures, another study did not identify any patient comorbidities as risk factors for acute infection.…”

“… 19 In that same study though, a higher American Society of Anesthesiologists score, congestive heart failure, and hypertension were associated with acute infection. 19 In 480 patients with tibial shaft fractures, another study did not identify any patient comorbidities as risk factors for acute infection. 13 By contrast, our study specifically investigated open tibial shaft fractures and accounted for patient comorbidities granularly as compared with amalgamated scores such as CCI or American Society of Anesthesiologists.…”

“…Previous studies investigating acute infection in open tibial shaft fractures have mostly focused on intrinsic injury characteristics and extrinsic variables such as antibiotic prophylaxis, time to débridement , soft-tissue management, and surgical management. 3,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] These factors (fracture type, severity of injury, soft-tissue compromise, and antibiotic and surgical timing) all play an important role in the development of acute infection in open tibial shaft fractures. However, the effect of intrinsic patient characteristics on the development of acute infection has not been studied as extensively.…”

Minimal Clinically Important Differences of Patient-Reported Outcomes Measurement Information System Physical Function in Patients With Tibial Shaft Fracture

“…Similarly, during this period, patients are also likely progressing to union, which increases the PROMIS PF score differences as patients return The literature cites high rates of risk factors and complications after tibial shaft fractures including roughly 15%-39% are open fractures, infection rate of 2%-30%, and nonunion rate ranging 3%-7%, and reoperation rates ranging from 12% to 44%. 1,[3][4][5][6][7][8][9][10][11]39 This study had similar rates of open fractures and complications with 104 (27.2%) open fractures, 25 (6.5%) infections, 42 (11%) nonunions, and 104 (27.2%) secondary surgeries. This lends confidence to that the overall cohort is representative of operatively treated tibial shaft fractures.…”

A new technology combined robotics and 3D printing facilitates closed reduction of tibia shaft fractures using a minimally invasive plate as a reduction template: A technical note.

“…(5)(6)(7)(8) Malalignment is a common complication of IMN for TSFs, which has been reported to account for 19-41% of cases, (9,10) due to the lack of endosteal t at the fracture site and the means of assessing rotation around the shaft axis intra-operatively. (11) Malalignment of MIPO for TSFs has a similar incidence because the technical complexity of achieving anatomical alignment made closed reduction a demanding surgical technique. (7) The radiation exposure of the operating staff and the patient are another serious de ciency associated with MIPO and IMN which is caused by closed reduction.…”