Plate assisted intramedullary nailing of Gustilo type IIIB open tibial diaphyseal fractures: Does adjunctive plate retention affect complication rate?J Orthop Trauma. 2020 Jan 14 [Online ahead of print]JO
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.
Consecutive cohort study.
One hundred and thirty seven consecutive patients with a Gustilo-Anderson 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.
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.
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).
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.
LEVEL OF EVIDENCE
Therapeutic level III.