title: Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists.
abstract: We hypothesized that less malalignment and complications occur with intramedullary nailing of distal third tibia fractures (42A, B, C) after the implementation of orthopedic trauma surgeons to this level II community hospital. We also hypothesized that patients with < or =5 degrees of malalignment have poorer function as measured by the MODEMS functional outcome scale. Two cohorts of distal third tibia fractures were identified by discharge diagnosis or by the Orthopaedic Trauma Association database. Group I (n = 39) patients were stabilized with an intramedullary nail by community orthopedic surgeons. Group II (n = 18) patients were treated by orthopedic trauma surgeons. In Group I (community), 9 (23%) patients treated by the community surgeons exhibited >5 degrees of angulation in at least one direction. Five (13%) of these patients displayed angulation in more than one direction, and 3 of these patients exhibited >10 degrees of angulation. In Group II (trauma) 1 (5%) patient had >5 degrees angulation in any plane (P < .05). No differences were noted in time to union, nonunion, delayed union, hardware failure or infections between the two groups. Functional outcomes were assessed using the MODEMS lower limb module. In comparison of the patients with and without significant angulation, the P value for bodily pain was 0.042. Patients treated by the community orthopedic surgeons had a higher incidence of malalignment, as compared to those treated by orthopedic trauma specialists.
authors.affiliation: Department of Orthopedics and Rehabilitation, Division of Orthopedic Trauma, Vanderbilt University Medical Center, Nashville, TN 37232-3450, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.forename: Miguel
authors.initials: M
authors.lastname: Medina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000592:standards / Q000639:trends; D011183:Postoperative Complications; D011336:Probability; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014193:Trauma Centers; D016896:Treatment Outcome