Distal tibia fractures and medial plating: factors influencing re-operation.
OBJECTIVE
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.
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@vanderbilt.edu.
Vasanth
V
Sathiyakumar
Rachel V
RV
Thakore
Rivka C
RC
Ihejirika
William T
WT
Obremskey
Manish K
MK
Sethi
D000328:Adult; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013978:Tibial Fractures / Q000150:complications* / Q000601:surgery*