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Distal tibia fractures and medial plating: factors influencing re-operation

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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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Authors and Affiliations

  1. The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200 Medical Center East, South Tower, Nashville, TN, 37232, USA

    Vasanth Sathiyakumar, Rachel V. Thakore, Rivka C. Ihejirika, William T. Obremskey & Manish K. Sethi

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  1. Vasanth Sathiyakumar
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  2. Rachel V. Thakore
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  3. Rivka C. Ihejirika
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  4. William T. Obremskey
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  5. Manish K. Sethi
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Correspondence to Manish K. Sethi.

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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

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