Sathiyakumar Vasanth, Thakore Rachel V, Ihejirika Rivka C, Obremskey William T, Sethi Manish K
The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200 Medical Center East, South Tower, Nashville, TN, 37232, USA,
Int Orthop. 2014 Jul;38(7):1483-8. doi: 10.1007/s00264-014-2345-7. Epub 2014 Apr 27.
We compared types of complications leading to re-operations in open and closed distal tibia fractures treated by locking or nonlocking medial plates.
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.
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.
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.
我们比较了采用锁定或非锁定内侧钢板治疗的开放性和闭合性胫骨远端骨折导致再次手术的并发症类型。
确定了2002年至2012年间93例接受切开复位内固定（ORIF）及内侧钢板固定治疗胫骨远端关节外或部分关节内骨折的患者。回顾病历以确定基于所发生并发症类型的再次手术发生率。采用Fisher精确检验和卡方检验分析基于损伤类型和所用钢板类型的并发症发生率。
33例（35.5%）患者需要再次手术：闭合性损伤患者中有28.6%（n = 16）因并发症而需要再次手术，而开放性损伤患者中有45.9%（n = 17）需要再次手术（p = 0.12）。闭合性损伤患者因内固定物疼痛/突出而更有可能需要再次手术（p = 0.03），而开放性损伤患者因骨不连而更有可能需要再次手术（p = 0.04）。两组之间在感染（p = 0.66）或畸形愈合（p = 0.99）方面无显著差异。锁定钢板成本较高，但与再次手术风险降低无关。
胫骨远端内侧钢板固定的再次手术率较高，开放性与闭合性组之间再次手术的原因存在显著差异。并发症发生率不受锁定钢板使用的影响。本研究结果表明，应考虑根据骨折类型采取方法来减少再次手术，如早期植骨或对开放性骨折使用替代植入物。
