Percutaneous or Open Reduction of Closed Tibial Shaft Fractures During Intramedullary Nailing Does Not Increase Wound Complications, Infection or Nonunion Rates.
OBJECTIVE
To compare the incidence of complications (wound, infection, and nonunion) among those patients treated with closed, percutaneous, and open intramedullary nailing for closed tibial shaft fractures.


METHODS
Retrospective review.


METHODS
Multiple trauma centers.


METHODS
Skeletally mature patients with closed tibia fractures amenable to treatment with an intramedullary device.


METHODS
Intramedullary fixation with closed, percutaneous, or open reduction.


METHODS
Superficial wound complication, deep infection, nonunion.


RESULTS
A total of 317 tibial shaft fractures in 315 patients were included in the study. Two-hundred fractures in 198 patients were treated with closed reduction, 61 fractures in 61 patients were treated with percutaneous reduction, and 56 fractures in 56 patients were treated with formal open reduction. The superficial wound complication rate was 1% (2/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 3.6% (2/56) for the open group with no statistical difference between the groups (P = 0.179). The deep infection rate was 2% (4/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 7.1% (4/56) for the open group with no significant difference between the groups (P = 0.133). Nonunion rate was 5.0% (10/200) for the closed group, 4.9% (3/61) for the percutaneous group, and 7.1% (4/56) for the open group, with no statistical difference between the groups (P = 0.492).


CONCLUSIONS
This is the largest reported series of closed tibial shaft fractures nailed with percutaneous and open reduction. Percutaneous or open reduction did not result in increased wound complications, infection, or nonunion rates. Carefully performed percutaneous or open approaches can be safely used in obtaining reduction of difficult tibial shaft fractures treated with intramedullary devices.


METHODS
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
*Florida Orthopaedic Institute, Orthopaedic Trauma Service, Tampa General Hospital, Tampa, FL; †Upstate Orthopedics, Syracuse, NY; ‡University of South Florida School of Medicine, Tampa, FL; and §Hughston Trauma, Fort Walton Beach, FL.
Darryl A
DA
Auston
Jordan
J
Meiss
Rafael
R
Serrano
Thomas
T
Sellers
Gregory
G
Carlson
Timothy
T
Hoggard
Michael
M
Beebe
Jonathan
J
Quade
David
D
Watson
Robert Bruce
RB
Simpson
Brian
B
Kistler
Anjan
A
Shah
Roy
R
Sanders
Hassan R
HR
Mir
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005431:Florida / Q000453:epidemiology; D005594:Fracture Fixation, Intramedullary / Q000706:statistics & numerical data*; D017759:Fractures, Malunited / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000070799:Open Fracture Reduction / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D013978:Tibial Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult