Abstract
Purpose
We compared types of complications leading to re-operations in open and closed distal tibia fractures treated by locking or nonlocking medial plates.
Methods
Ninety-three patients from 2002 to 2012 who underwent open reduction and internal fixation (ORIF) and medial plating for distal extra-articular or partial articular tibia fractures were identified. Charts were retrospectively reviewed to determine the incidence of re-operation based on the type of complication that developed. Fisher’s exact and chi-square tests were performed to analyze the incidence of complications based on injury and type of plate used.
Results
Thirty-three (35.5 %) patients required re-operations: 28.6 % (n = 16) with closed injuries had complications leading to re-operations compared with 45.9 % (n = 17) of patients with open injuries (p = 0.12). Patients with closed injuries were more likely to require re-operation due to hardware pain/prominence (p = 0.03), whereas patients with open injuries were more likely to require re-operation due to nonunion (p = 0.04). There were no significant differences in infection (p = 0.66) or malunion (p = 0.99) between groups. Locking plates showed higher costs but were not associated with decreased risk of re-operation.
Conclusions
There was a high re-operation rate associated with distal tibia medial plating, with significant differences in the reason for re-operation between open versus closed groups. Complication rates were not influenced by the use of locking plates. Results of this study suggest that methods be considered to reduce re-operation based on type of fracture, such as early bone grafting or the use of alternate implants for open fractures.
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Conflicts of interest and source of funding
William Obremskey previously consulted for biometrics and provided expert testimony in legal matters. The institution of WTO received a grant from the Department of Defense. For the remaining authors, there are no conflicts of interest.
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Sathiyakumar, V., Thakore, R.V., Ihejirika, R.C. et al. Distal tibia fractures and medial plating: factors influencing re-operation. International Orthopaedics (SICOT) 38, 1483–1488 (2014). https://doi.org/10.1007/s00264-014-2345-7
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DOI: https://doi.org/10.1007/s00264-014-2345-7