S12.2 RISK FACTORS OF THE DEVELOPMENT OF A POSTTRAUMATIC OSTEITIS OF THE TIBIA DEPENDING ON THE FRACTURE LOCATION

Abstract

Objectives: Goal of this retrospective study is to evaluate risk factors, which lead to an osteitis of the tibia depending on the fracture location.

Methods: The study was initiated 01/2002. The study population consists of 104 patients including 14 women (13%). All of them suffered from an osteitis of the tibial. All of them are complications after traumatic open or closed fractures of the tibia, treated surgical. The average age of the patients has been 48 (± 18) years. In 28 cases there has been an acute osteitis of the tibia. In the other 76 patients the infection was not noticed before the ninth week after trauma. In all patients the risk factors were analyzed depending on the fracture configuration, the soft tissue situation, and the fracture location.

Results: All infections have been localized at the fracture level. The majority of the patients suffered from open tibial fractures (77.4%). 7.9% have been first, 23.6% second, and 68.5% third degree open fractures. Almost half of the fractures (48.1%) were located at the distal third of the tibia. Equally, 25.9% of the infections were localized in the medial and proximal third of the tibia. The percentage of open fractures leading to an osteitis was significant highest (p < 0.01) at the medial third of the tibia (91.3%), whereas the percentage of open proximal fractures has been 61.1% and open distal fractures 62%. The complexity of the fractures of the proximal, medial, and distal third of the tibia was very similar. The proportion of osteosynthesis with fixateur externe, plating, or naling showed no significant differences. 37.8% of the patients were smoker. The percentage of smoker was significant highest (p < 0.05) in the subgroup osteitis after closed tibial fracture (69.9%). The number of the other risk factors (Diabetes mellitus, hypertension, alcohol consumption, adipositas, PAD) was similar in all subgroups. There have been no differences between the 28 acute versus the 76 chronic osteitis.

Conclusion: The majority of the posttraumatic tibial osteitis is localised in the distal third. The most important risk factor for the development of a posttraumatic tibial osteitis is the dimension of the soft tissue defect. This is particularly true for the medial third of the tibia where the percentage of open fractures is significant highest. Additionally nicotine consumption is a major risk factor for the development of a posttraumatic tibial osteitis, particularly in cases of closed distal tibial fractures.