Fractures ouvertes de jambe

Risk factors for complications after primary intramedullary nailing to treat tibial shaft fractures: A cohort study of 184 consecutive patients

BACKGROUND

Intramedullary nailing is the standard of care for tibial shaft fractures. The risk factors for infectious and/or mechanical complications, notably non-union, remain incompletely understood. The objective of this study was to evaluate risk factors for complications, notably non-union.

HYPOTHESIS

Active smoking and an initial open wound are independent risk factors for complications.

MATERIALS AND METHODS

We retrospectively included consecutive patients managed for open or closed tibial shaft fractures by primary intramedullary nailing between 2013 and 2018. We collected data on preoperative factors related to the patient and to the mechanism of injury (age, sex, smoking history, energy of the trauma, open wound), on intraoperative factors (residual interfragmentary gap), and on postoperative factors (early or delayed weight-bearing). We evaluated the associations between these factors and the occurrence of complications, notably non-union, by performing a univariate analysis followed by a multivariate analysis.

RESULTS

We included 184 patients [mean age, 38.5±17.6 (range, 15-91), 72.2% of males]. One or more complications developed in 28 (15.2%) patients and non-union occurred in 15 (8.1%) patients. There were three significant risk factors for complications: active smoking (OR, 7.93; 95%CI, 2.76-22.7), a residual interfragmentary gap >5mm (OR, 4.92; 95%CI, 1.72-14.02), and an initial open wound (OR,5.16; 95%CI, 1.62-16.43) (p<0.05). The same three factors were significant risk factors for non-union. Energy of the trauma, age, sex, and early or delayed weight bearing were not significantly associated with an excess risk of complications.

DISCUSSION

Active smoking, a residual interfragmentary gap >5mm, and an initial open wound are risk factors for postoperative complications after intramedullary nailing to treat a tibial shaft fracture. Preventive strategies and specific information could be implemented for these patients.

LEVEL OF EVIDENCE

IV; single-centre retrospective cohort study.

Attaining tibiofibular union using an inter-tibiofibular autograft. A series of 43 cases

INTRODUCTION

This study consisted of a series of 43 patients with lower leg non-union that were treated with an inter-tibiofibular autograft (ITFG).

MATERIAL AND METHODS

After reviewing the surgical technique, the overall theory behind the treatment is described, including stabilization, soft tissue repair, infection control if necessary and then performing a procedure to help achieve bone union.

RESULTS

After an average follow-up of 2 years, all the patients achieved union, but some required additional procedures. Only one patient had a delayed reactivation of the infection, which was successfully treated.

CONCLUSION

A broad set of indications for ITFG are proposed for lower leg non-union cases, in particular non-infected cases.

LEVEL OF EVIDENCE

Level IV. Retrospective study.