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Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review

2019; Lippincott Williams & Wilkins; Volume: 34; Issue: 6 Linguagem: Inglês

10.1097/bot.0000000000001709

1531-2291

Kathryn B. Metcalf, Eric Smith, Robert J. Wetzel, John K. Sontich, George Ochenjele,

Hip and Femur Fractures

Objective: To assess the outcomes of patients who sustained blunt trauma tibia fractures compared with tibia fractures from civilian gunshot injuries when treated with intramedullary fixation. Design: Retrospective chart review. Setting: Level I trauma center. Patients/Participants: Two hundred and seven patients underwent intramedullary nailing for 211 tibia fractures. Methods: A retrospective review of tibia fracture(s) treated with intramedullary fixation with comparison of closed, open, and gunshot wound (GSW) fracture outcomes. Main Outcome Measurements: Outcomes included infection and nonunion. Results: The infection rate in closed and GSW tibia fractures was significantly lower compared with the infection rate of open fractures (1% vs. 9% vs. 20%; P = 0.00005). Significantly lower rates of nonunion in closed fractures compared with open fractures and GSW fractures were appreciated (8% vs. 20% vs. 30%; P = 0.003). There was no difference in infection or nonunion between GSW fractures with small wounds, no exposed bone, and minimal comminution and closed injuries ( P = 0.24, P = 0.60). Conversely, there was a significantly higher nonunion rate in GSW fractures with large wounds, exposed tibia, and comminution compared with blunt injuries ( P = 0.0014). Conclusions: This study suggests that tibia fractures from civilian GSWs are heterogeneous injuries, and outcomes are dependent on the extent of soft-tissue injury, bone exposure, and bone loss. There are comparable infection rates in all fractures due to civilian GSWs and closed fractures, which are lower than high-grade open fractures. Tibia GSW fractures with exposed bone and comminution have higher complication rates and should be treated accordingly. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.