Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review
| Autor: | Eric J. Smith, Kathryn B. Metcalf, Robert J. Wetzel, John K. Sontich, George Ochenjele |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Nonunion Tibia Fracture Wounds Nonpenetrating law.invention Intramedullary rod 03 medical and health sciences Closed Fracture 0302 clinical medicine law Humans Medicine Orthopedics and Sports Medicine Tibia Retrospective Studies Fracture Healing 030222 orthopedics business.industry Trauma center 030208 emergency & critical care medicine General Medicine musculoskeletal system medicine.disease Fracture Fixation Intramedullary Surgery Tibial Fractures Treatment Outcome Blunt trauma Wounds Gunshot Gunshot wound business |
| Zdroj: | Journal of Orthopaedic Trauma. 34:e208-e213 |
| ISSN: | 0890-5339 |
| DOI: | 10.1097/bot.0000000000001709 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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