Justin M Haller1, Michael Githens, John Scolaro, Reza Firoozabadi. 1. *Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT; †Department of Orthopedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA; and ‡Department of Orthopedic Surgery, University of California, Irvine, Orange, CA.
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.
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.
Authors: Richard J Behlmer; Paul S Whiting; Stephanie A Kliethermes; Linder Wendt; Natasha M Simske; Eleanor H Sato; Christopher J Doro; David C Goodspeed; Gerald J Lang Journal: OTA Int Date: 2021-02-02