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The role of plating in the operative treatment of severe open tibial fractures: a systematic review

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Abstract

Open fractures of the tibial diaphysis are the result of high-energy trauma. They are usually associated with extensive soft tissue loss and represent serious clinical problems. Surgical treatment of these injuries has been associated with substantial complications such as osteomyelitis, delayed bone healing, poor functional outcome, soft-tissue failure, or even amputations. More recently a staged treatment, with initial application of spanning external fixators followed by definitive fixation at secondary phase, has been advocated. Plating of these fractures in the acute setting remains a topic of heated discussion. A systematic review of the literature was carried out in order to investigate the existing evidence concerning the efficacy and safety of this method of osteosynthesis. Eleven papers met the inclusion criteria, accumulating 492 open tibial fractures treated with plating. The overall union rate ranged from 62–95% across all studies, with time to union ranging from 13–42 weeks. The reoperation rate ranged from 8–69% and a pooled estimate of deep infection rate was calculated at 11%. Plate fixation for the treatment of open tibial fractures can be considered under specific conditions which need to be elicited and clarified with future well-designed and conducted clinical trials.

Résumé

Les fractures ouvertes de la diaphyse tibiale sont généralement secondaires à un traumatisme violent. Elles sont généralement associées avec des lésions ou des pertes de substance des tissus mous. Ceci entraîne de sérieux problèmes thérapeutiques. Le traitement chirurgical de ces traumatismes est émaillé de sérieuses complications: infections, retards de consolidation, problèmes fonctionnels, lésions persistantes des tissus mous, ces complications pouvant parfois conduire à une amputation. Récemment, un traitement en deux étapes a été mis au point avec mise en place initiale d’un fixateur externe, suivi secondairement par une fixation définitive. L’ostéosynthèse par plaques de ces fractures, en période aigue reste un domaine très discuté. Une revue systématique de la littérature nous a permis d’évaluer les résultats de cette méthode d’ostéosynthèse. 11 articles regroupant 492 fractures ouvertes traitées par plaque ont pu être recensés. Le taux de consolidation varie de 62 à 95% avec un temps de consolidation de 13 à 42 semaines. Le taux de réintervation varie également de 8 à 69% et le taux d’infection profonde peut être estimé à 11%. L’ostéosynthèse par plaque dans le traitement des fractures ouvertes peut être considérée, sous certaines conditions, comme un traitement dont les résultats peuvent être parfaitement définis ceci nécessitant également quelques études ultérieures.

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References

  1. Audige L, Bhandari M, Griffin D, et al (2004) Systematic reviews of nonrandomized clinical studies in the orthopaedic literature. Clin Orthop Relat Res 249–257

  2. Bach AW, Hansen ST, Jr. (1989) Plates versus external fixation in severe open tibial shaft fractures. A randomized trial. Clin Orthop Relat Res 89–94

  3. Bilat C, Leutenegger A, Ruedi T (1994) Osteosynthesis of 245 tibial shaft fractures: early and late complications. Injury 25: 349–358

    Article  PubMed  CAS  Google Scholar 

  4. Brumback RJ (1992) Open tibial fractures: current orthopaedic management. Instr Course Lect 41: 101–117

    PubMed  CAS  Google Scholar 

  5. Clifford RP, Beauchamp CG, Kellam JF, et al (1988) Plate fixation of open fractures of the tibia. J Bone Joint Surg Br 70: 644–648

    PubMed  CAS  Google Scholar 

  6. Court-Brown CM, McBirnie J (1995) The epidemiology of tibial fractures. J Bone Joint Surg Br 77: 417–421

    PubMed  CAS  Google Scholar 

  7. Court-Brown CM, Wheelwright EF, Christie J, McQueen MM (1990) External fixation for type III open tibial fractures. J Bone Joint Surg Br 72: 801–804

    PubMed  CAS  Google Scholar 

  8. Crowley DJ, Kanakaris NK, Giannoudis PV (2007) Debridement and wound closure of open fractures: The impact of the time factor on infection rates. Injury May 25 [Epub ahead of print]

  9. Crowley DJ, Kanakaris NK, Giannoudis PV (2007) Irrigation of the wounds in open fractures. J Bone Joint Surg Br 89: 580–585

    Article  PubMed  CAS  Google Scholar 

  10. Farouk O, Krettek C, Miclau T, et al (1997) Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 28 Suppl 1: A7–A12

    Article  PubMed  Google Scholar 

  11. Giannoudis PV, Papakostidis C, Roberts C (2006) A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br 88: 281–289

    Article  PubMed  CAS  Google Scholar 

  12. Gopal S, Majumder S, Batchelor AG, et al (2000) Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br 82: 959–966

    Article  PubMed  CAS  Google Scholar 

  13. Gregory P, Sanders R (1995) The management of severe fractures of the lower extremities. Clin Orthop Relat Res 95–105

  14. Gustilo RB, Merkow RL, Templeman D (1990) The management of open fractures. J Bone Joint Surg Am 72: 299–304

    PubMed  CAS  Google Scholar 

  15. Jensen JS, Hansen FW, Johansen J (1977) Tibial shaft fractures. A comparison of conservative treatment and internal fixation with conventional plates or AO compression plates. Acta Orthop Scand 48: 204–212

    Article  PubMed  CAS  Google Scholar 

  16. Keating JF, O’Brien PJ, Blachut PA, et al (1997) Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am 79: 334–341

    PubMed  CAS  Google Scholar 

  17. Korovessis P, Milis Z, Christodoulou G, et al (1992) Open tibial shaft fractures: a comparative analysis of different methods of fixation in southwestern Greece. J Trauma 32: 77–81

    Article  PubMed  CAS  Google Scholar 

  18. Kristensen KD (1979) Tibial shaft fractures. The frequency of local complications in tibial shaft fractures treated by internal compression osteosynthesis. Acta Orthop Scand 50: 593–598

    Article  PubMed  CAS  Google Scholar 

  19. Langenberg R (1987) [Results of surgical therapy of open tibial shaft fractures]. Zentralbl Chir 112: 1508–1514

    PubMed  CAS  Google Scholar 

  20. Littenberg B, Weinstein LP, McCarren M, et al (1998) Closed fractures of the tibial shaft. A meta-analysis of three methods of treatment. J Bone Joint Surg Am 80: 174–183

    PubMed  CAS  Google Scholar 

  21. Montori VM, Swiontkowski MF, Cook DJ (2003) Methodologic issues in systematic reviews and meta-analyses. Clin Orthop Relat Res 43–54

  22. Muller ME, Allgower M, Schneider R, Willeneger H (1991) Manual of Internal Fixation. Springer-Verlag, Heidelberg

  23. Oh CW, Park BC, Ihn JC, Park HJ (2001) Primary unreamed intramedullary nailing for open fractures of the tibia. Int Orthop 24: 338–341

    Article  PubMed  CAS  Google Scholar 

  24. Olson SA (1997) Open fractures of the tibial shaft. Instr Course Lect 46: 293–302

    PubMed  CAS  Google Scholar 

  25. Patzakis MJ, Wilkins J, Moore TM (1983) Considerations in reducing the infection rate in open tibial fractures. Clin Orthop Relat Res 36–41

  26. Perren SM (2002) The technology of minimally invasive percutaneous osteosynthesis (MIPO). Injury 33 Suppl 1: VI–VII

    Article  PubMed  Google Scholar 

  27. Ruedi T, Webb JK, Allgower M (1976) Experience with the dynamic compression plate (DCP) in 418 recent fractures of the tibial shaft. Injury 7: 252–257

    Article  PubMed  CAS  Google Scholar 

  28. Sanders R, Jersinovich I, Anglen J, et al (1994) The treatment of open tibial shaft fractures using an interlocked intramedullary nail without reaming. J Orthop Trauma 8: 504–510

    PubMed  CAS  Google Scholar 

  29. Sanders R, Swiontkowski M, Nunley J, Spiegel P (1993) The management of fractures with soft-tissue disruptions. J Bone Joint Surg Am 75: 778–789

    PubMed  CAS  Google Scholar 

  30. Singh S, Ng KC, Chia P (1997) Plating of displaced mid-tibial fractures-a retrospective review of 80 cases. Singapore Med J 38: 58–61

    PubMed  CAS  Google Scholar 

  31. Vara-Thorbeck R, Ruiz-Morales M, Hernandez-Hernandez MA (1989) [Conservative management versus osteosynthesis in the treatment of tibial shaft fractures]. Zentralbl Chir 114: 757–765

    PubMed  CAS  Google Scholar 

  32. Wagner M, Frenk A, Frigg R (2004) New concepts for bone fracture treatment and the Locking Compression Plate. Surg Technol Int 12: 271–277

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Professor of Trauma & Orthopaedic Surgery School of Medicine, University of Leeds, Leeds, UK

    Peter V. Giannoudis

  2. AO Fellow, Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK

    Costas Papakostidis

  3. Clinical Fellow, Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK

    George Kouvidis

  4. Trauma Fellow, Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK

    Nikolaos K. Kanakaris

  5. Academic Department of Trauma and Orthopaedics Clarendon Wing, Level A, Leeds General Infirmary - LGI, Great George Street, Leeds, LS1 3EX, United Kingdom

    Peter V. Giannoudis

Authors
  1. Peter V. Giannoudis
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  2. Costas Papakostidis
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  3. George Kouvidis
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  4. Nikolaos K. Kanakaris
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Corresponding author

Correspondence to Peter V. Giannoudis.

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Academic Unit, Trauma and Orthopaedic Surgery, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.

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Giannoudis, P.V., Papakostidis, C., Kouvidis, G. et al. The role of plating in the operative treatment of severe open tibial fractures: a systematic review. International Orthopaedics (SICO 33, 19–26 (2009). https://doi.org/10.1007/s00264-007-0443-5

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  • DOI: https://doi.org/10.1007/s00264-007-0443-5

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