Tang Peter, Gates Charley, Hawes Justin, Vogt Molly, Prayson Michael J
University of Pittsburgh, USA.
J Orthop Trauma. 2006 May;20(5):317-22. doi: 10.1097/00005131-200605000-00004.
To evaluate whether an open technique used to obtain reduction during intramedullary nailing of closed tibial shaft fractures increases the risk of infection, compared to closed reduction and nailing.
University level 1 trauma center.
Retrospective database analysis.
PATIENTS/PARTICIPANTS: One hundred seventeen patients with 119 fractures from our trauma database who had sufficient follow-up and met study criteria. The patients were grouped by open versus closed reduction. Only OTA fracture types 42 A to C were included in this study.
Locked reamed intramedullary nailing for closed tibial shaft fractures accomplished through either open or closed reduction.
The presence or absence of infection as determined by the clinical presentation (erythema, warmth, purulent drainage, fevers, chills, increased pain at the fracture site), indicative laboratory work (complete blood count, erythrocyte sedimentation rate, C-reactive protein), and/or positive culture.
There were 85 males and 32 females. The average age was 35.7 years; the average follow-up was 14.3 months. Of the 119 fractures, 79 had closed reduction whereas 40 had open reduction. The open reductions consisted of 13 with a formal incision (>1 cm in length), 22 with percutaneous incisions, and 5 with fasciotomies. There were no infections in the closed reduction group and 2 infections (5%) in the open reduction group. This difference was not statistically significant (P=0.1). The average time to union was 7.0 months in closed reductions and 7.3 months in open reductions. By latest follow-up, 107 fractures had reached union (89.9%), 1 had not (0.8%), and 11 were lost to final follow-up (9.2%).
Limited open techniques can greatly facilitate the reduction of closed tibial shaft fractures but raise concern for infection through exposure of the fracture site. This study found that the rate of infection for open versus closed reductions was higher but not statistically different. Judicious use of open reduction techniques during intramedullary nailing of closed tibia fractures seems to have a minimal risk of infection.
与闭合复位髓内钉固定相比，评估用于闭合胫骨干骨折髓内钉固定时获得复位的开放技术是否会增加感染风险。
大学一级创伤中心。
回顾性数据库分析。
患者/参与者：从我们的创伤数据库中选取117例患者的119处骨折，这些患者有足够的随访资料且符合研究标准。患者按开放复位与闭合复位分组。本研究仅纳入OTA 42 A至C型骨折。
通过开放或闭合复位完成闭合胫骨干骨折的带锁扩髓髓内钉固定。
根据临床表现（红斑、发热、脓性引流、发热、寒战、骨折部位疼痛加剧）、指示性实验室检查（全血细胞计数、红细胞沉降率、C反应蛋白）和/或阳性培养结果确定是否存在感染。
男性85例，女性32例。平均年龄35.7岁；平均随访14.3个月。119处骨折中，79处采用闭合复位，40处采用开放复位。开放复位包括13例有正式切口（长度>1 cm）、22例经皮切口和5例筋膜切开术。闭合复位组无感染，开放复位组有2例感染（5%）。这种差异无统计学意义（P=0.1）。闭合复位的平均愈合时间为7.0个月，开放复位为7.3个月。至最新随访时，107处骨折已愈合（89.9%），1处未愈合（0.8%），11处失访（9.2%）。
有限的开放技术可极大地促进闭合胫骨干骨折的复位，但因骨折部位暴露而引发感染担忧。本研究发现开放复位与闭合复位的感染率较高，但无统计学差异。在闭合胫骨骨折髓内钉固定期间明智地使用开放复位技术似乎感染风险极小。
