Robert M Corey1, Nathan K Park2, Lisa K Cannada1. 1. Department of Orthopaedics, Saint Louis University, St. Louis, MO. 2. Saint Louis University School of Medicine, St. Louis, MO.
Abstract
OBJECTIVES: To determine the most commonly associated injuries, complications, and healing rates of patients sustaining segmental tibial shaft fractures. DESIGN: Retrospective review. SETTING: Two Level I trauma centers. PATIENTS: A total of 108 patients with segmental tibial shaft fractures were identified between 2005 and 2013. INTERVENTION: None. MAIN OUTCOME MEASURES: Demographics, injury characteristics, treatments, and complications. Categories were evaluated and analyzed based on frequency of occurrence. Time to union was assessed based on serial radiographs. RESULTS: A total of 108 patients met the inclusion criteria. All fractures were OTA/AO type 42C2. Seventy-three patients (68%) sustained open fractures. There were 34 patients (31%) who had compartment syndrome. The median Injury Severity Score was 27 (range 4-75). Ninety-five patients underwent reamed intramedullary nailing of the tibia, 4 underwent open reduction internal fixation, and 2 patients were definitively treated with external fixation. The median length of hospital stay was 11 days (range 3-48). Outcome data (time to union/delayed union/malunion) was available for 101 patients. The median time to union was 26 weeks (range 14-48). The delayed union rate was 40% (40/101) and the nonunion rate was 10% (10/101). CONCLUSION: Segmental tibial shaft fractures are often associated with severe polytrauma and are most often open fractures. Reamed intramedullary nailing after appropriate resuscitative and stabilization methods can result in excellent alignment and union in these fractures, with low nonunion and infection rates at 1 year. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: To determine the most commonly associated injuries, complications, and healing rates of patients sustaining segmental tibial shaft fractures. DESIGN: Retrospective review. SETTING: Two Level I trauma centers. PATIENTS: A total of 108 patients with segmental tibial shaft fractures were identified between 2005 and 2013. INTERVENTION: None. MAIN OUTCOME MEASURES: Demographics, injury characteristics, treatments, and complications. Categories were evaluated and analyzed based on frequency of occurrence. Time to union was assessed based on serial radiographs. RESULTS: A total of 108 patients met the inclusion criteria. All fractures were OTA/AO type 42C2. Seventy-three patients (68%) sustained open fractures. There were 34 patients (31%) who had compartment syndrome. The median Injury Severity Score was 27 (range 4-75). Ninety-five patients underwent reamed intramedullary nailing of the tibia, 4 underwent open reduction internal fixation, and 2 patients were definitively treated with external fixation. The median length of hospital stay was 11 days (range 3-48). Outcome data (time to union/delayed union/malunion) was available for 101 patients. The median time to union was 26 weeks (range 14-48). The delayed union rate was 40% (40/101) and the nonunion rate was 10% (10/101). CONCLUSION: Segmental tibial shaft fractures are often associated with severe polytrauma and are most often open fractures. Reamed intramedullary nailing after appropriate resuscitative and stabilization methods can result in excellent alignment and union in these fractures, with low nonunion and infection rates at 1 year. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.