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Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Soft tissues (wound dehiscence, skin necrosis) and septic (wound infection, osteomyelitis) complications have been historically recognized as the most frequent complications in surgical treatment of high-energy proximal tibia fractures (PTFs). Staged management with a temporary external fixator is a commonly accepted strategy to prevent these complications. Nonetheless, there is a lack of evidence about when and how definitive external or internal definitive fixation should be chosen, and which variables are more relevant in determining soft tissues and septic complications risk. The aim of the present study is to retrospectively evaluate at midterm follow-up the results of a staged management protocol applied in a single trauma center for selective PTFs.

Methods

The study population included 24 cases of high-energy PTFs treated with spanning external fixation followed by delayed internal fixation. Severity of soft tissues damage and fracture type, timing of definitive treatment, clinical (ROM, knee stability, WOMAC and IOWA scores) and radiographic results as well as complications were recorded.

Results and conclusion

Complex fracture patterns were prevalent (AO C3 58.3%, Schatzker V–VI 79.1%), with severe soft tissues damage in 50% of cases. Mean time to definitive internal fixation was 6 days, with double-plate fixation mostly chosen. Clinical results were highly satisfying, with mean WOMAC and IOWA scores as 21.3 and 82.5, respectively. Soft tissue complication incidence was very low, with a single case of wound superficial infection (4.3%) and no cases (0%) of deep infection, skin necrosis or osteomyelitis. Staged management of high-energy PTFs leads to satisfying clinical and radiographic results with few complications in selected patients.

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Authors and Affiliations

  1. Orthopaedics and Trauma Unit, Cattinara Hospital, ASUITS, Strada di Fiume 447, 34149, Trieste, Italy

    Gianluca Canton, Antonio Moretti & Luigi Murena

  2. Orthopaedics and Trauma Unit, Emergency Department, Policlinico San Martino Hospital, Largo R. Benzi 10, 16132, Genoa, Italy

    Federico Santolini

  3. Orthopaedics and Trauma Unit, Ente Ospedaliero Ospedali Galliera, Mura delle Cappuccine 14, 16148, Genoa, Italy

    Marco Stella

  4. Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences, University of Insubria, Viale Luigi Borri 57, 21100, Varese, Italy

    Michele Francesco Surace

Authors
  1. Gianluca Canton
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  2. Federico Santolini
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  3. Marco Stella
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  4. Antonio Moretti
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  6. Luigi Murena
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Correspondence to Antonio Moretti.

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Authors Gianluca Canton, Luigi Murena, Antonio Moretti, Emmanuele Santolini, Marco Stella, Michele Francesco Surace declare that they have no conflict of interest.

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Canton, G., Santolini, F., Stella, M. et al. Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures. Eur J Orthop Surg Traumatol 30, 671–680 (2020). https://doi.org/10.1007/s00590-019-02619-9

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  • DOI: https://doi.org/10.1007/s00590-019-02619-9

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