Abstract
Objectives: To investigate the complication rates after use of retained adjunctive plate (RAP) fixation with intramedullary nailing of Gustilo-Anderson type IIIB open tibia
fractures, as part of a two-stage orthoplastic approach.
Design: Consecutive cohort study.
Patients/Participants: One hundred and thirty seven consecutive patients with a GustiloAnderson type IIIB open diaphyseal tibia fracture (OTA/AO 42) treated between May
2014 and January 2018. Nighty eight patients (RAP = 67; non-RAP = 31) met the inclusion criteria and underwent 2-stage reconstruction. All patients were treated using a
small fragment adjunctive plate to hold the fracture reduced prior to intramedullary nailing.
Intervention: At stage two, the temporary small fragment (in-fix) plate was removed and the site further thoroughly debrided. Following this the fracture is reduced and held with a new small fragment plate to facilitate the definitive intramedullary nailing. This new plate was either retained (RAP) as part of the definitive fixation at second stage or removed prior to wound coverage.
Main outcome measurement: The main outcome measures were re-operation rate, deep infection, nonunion and flap related complication.
Results: Six patients (6/98, 6.1%) proceeded to nonunion (RAP 5/67, non-RAP 1/31). This was not significant (p = 0.416). 212 operations were undertaken, the median was two. Sixteen (16/212, 7.5%) complication related re-operations were undertaken, affecting eight patients (8/67, 11.9%) in the RAP group. Eight patients (8/98, 8.2%) developed a deep infection (RAP 6/67, non-RAP 2/31). This was not significant (p = 0.674).
Conclusions: In the context of an orthoplastic approach, the use of a retained adjunctive plate with definitive intramedullary nailing does not appear to significantly increase the rate of deep infection or nonunion in patients with type IIIB open tibial shaft fractures.
fractures, as part of a two-stage orthoplastic approach.
Design: Consecutive cohort study.
Patients/Participants: One hundred and thirty seven consecutive patients with a GustiloAnderson type IIIB open diaphyseal tibia fracture (OTA/AO 42) treated between May
2014 and January 2018. Nighty eight patients (RAP = 67; non-RAP = 31) met the inclusion criteria and underwent 2-stage reconstruction. All patients were treated using a
small fragment adjunctive plate to hold the fracture reduced prior to intramedullary nailing.
Intervention: At stage two, the temporary small fragment (in-fix) plate was removed and the site further thoroughly debrided. Following this the fracture is reduced and held with a new small fragment plate to facilitate the definitive intramedullary nailing. This new plate was either retained (RAP) as part of the definitive fixation at second stage or removed prior to wound coverage.
Main outcome measurement: The main outcome measures were re-operation rate, deep infection, nonunion and flap related complication.
Results: Six patients (6/98, 6.1%) proceeded to nonunion (RAP 5/67, non-RAP 1/31). This was not significant (p = 0.416). 212 operations were undertaken, the median was two. Sixteen (16/212, 7.5%) complication related re-operations were undertaken, affecting eight patients (8/67, 11.9%) in the RAP group. Eight patients (8/98, 8.2%) developed a deep infection (RAP 6/67, non-RAP 2/31). This was not significant (p = 0.674).
Conclusions: In the context of an orthoplastic approach, the use of a retained adjunctive plate with definitive intramedullary nailing does not appear to significantly increase the rate of deep infection or nonunion in patients with type IIIB open tibial shaft fractures.
| Original language | English |
|---|---|
| Journal | Journal of Orthopaedic Trauma |
| Early online date | 14 Jan 2020 |
| DOIs | |
| Publication status | E-pub ahead of print - 14 Jan 2020 |
Bibliographical note
The acceptance date for this record is provisional and based upon the month of publication for the article.Keywords
- open fracture
- type IIIB
- tibia
- plate assisted nailing
- retained adjunctive plate
- RAP
- nonunion