FACTORS AFFECTING RATES OF INFECTION AND PROLONGED BONE HEALING IN 821 OPERATIVE TREATED ISOLATED TIBIAL SHAFT FRACTURES

Abstract

Purpose: We reviewed all isolated tibial shaft fractures treated by operative means, with focus on prolonged healing and infection. Design; Retrospective Case Control Study; level of evidence; Prognostic level III.

Methods: Patients: 821 isolated tibial shaft fractures, with a drop-out of 5.6% Open fractures: 400 (grade I & II 280, grade IIIa,b,c 120) Type A,B fractures: 597 Type C fractures: 224 Skeletal Fixation Modes: Ex;Fix (unilateral-one plane): 192, UTN(Synthes): 337, Plate(LCDCP): 129, RTN(Synthes): 163

Outcome measurements: Union time, requirement for secondary treatment, and development of deep infection.

Results: Infections: 94 (11,4%), Closed # which became infected: 21 (5%) Open # which became infected: 73 (18%) Ex.Fix: 56 (29%) Plate: 15 (12%) UTN: 16 (5%) RTN: 7 (5%) In a multiple logistic regression analysis, only Soft tissue damage had a statistical significant interference with the outcome infection (point estimate 0.117, 95% CI 0.053–0.262) Prolonged healing: 285 (34%)? Delayed union 191 ? Non-union 94 Closed fractures which develop a delayed healing: 56 (13%) Open fractures which develop a delayed healing: 135 (34%) Closed fractures which develop a non-union: 20 (5%) Open fractures which develop a non-union: 74 (19%) In a multiple logistic regression analysis, infection & fracture type had a statistical significant interference with the outcome prolonged healing.

Conclusions: The use of an unilateral external fixator as a definitive treatment for tibial fractures is obsolete. For a contaminated tibial fracture the use of the UTN diminish the risk of infection. Looking for the healing time, UTN & Ex.Fix. are associated with a significant prolonged bone healing time.