Complications in type III open tibial shaft fractures treated with open reduction and internal fixation
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: To estimate rates of fracture-related infection (FRI) and nonunion and assess the healthcare burden associated with FRI among patients with open reduction and internal fixation (ORIF) for Type III open tibial shaft fractures (TSFs). Methods: Patients with type III TSF requiring ORIF were identified using MarketScan® Database. Healthcare utilization and total costs were compared using generalized linear models. Results: The rates of FRI and nonunion were 35.99 and 36.94%, respectively, at 365 days. Patients with FRI had a significantly higher rate of readmission, emergency room visit and total healthcare costs compared with patients without FRI. Conclusion: Patients with an ORIF procedure for Type III TSF have a high risk of FRI and nonunion and; FRI significantly increased the healthcare burden.
Supplementary Material
File (supplementary appendix.docx)
- Download
- 29.11 KB
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Giannoudis PV, Papakostidis C, Roberts C. A review of the management of open fractures of the tibia and femur. J. Bone Joint Surg. Br. 88(3), 281–289 (2006).
•• Provides summary of outcomes for fixation in open fractures of tibia.
2.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J. Bone Joint Surg. Am. 58(4), 453–458 (1976).
3.
Johnson EN, Burns TC, Hayda RA, Hospenthal DR, Murray CK. Infectious complications of open type III tibial fractures among combat casualties. Clin. Infect. Dis. 45(4), 409–415 (2007).
• Characterizes the infections in type III tibial fractures.
4.
Metsemakers WJ, Morgenstern M, Mcnally MA et al. Fracture-related infection: a consensus on definition from an international expert group. Injury 49(3), 505–510 (2018).
5.
Lua J, Tan VH, Sivasubramanian H, Kwek E. Complications of open tibial fracture management: risk factors and treatment. Malays. Orthop. J. 11(1), 18–22 (2017).
•• Reviews the risk factors causing infective complications in open tibial fractures.
6.
Calori GM, Albisetti W, Agus A, Iori S, Tagliabue L. Risk factors contributing to fracture non-unions. Injury 38(Suppl. 2), S11–S18 (2007).
7.
Dahabreh Z, Calori GM, Kanakaris NK, Nikolaou VS, Giannoudis PV. A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7. Int. Orthop. 33(5), 1407–1414 (2009).
8.
Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH. Treatment of open fractures of the shaft of the tibia. J. Bone Joint Surg. Br. 83(1), 62–68 (2001).
• Compares different treatments in open tibial fractures and associated risks of infection and nonunion.
9.
Fong K, Truong V, Foote CJ et al. Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study. BMC Musculoskelet. Disord. 14, 103–103 (2013).
10.
Hak D, Saleh K, Nierengarten M. Socioeconomic burden of traumatic tibial fractures: nonunion or delayed union. MedScape Orthop. Clin. Updates 1–22 (2001).
11.
Antonova E, Le TK, Burge R, Mershon J. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskelet. Disord. 14, 42 (2013).
• Compares healthcare use and costs with tibial shaft fractures in patients with and without nonunion.
12.
Consumer Price Index (CPI) 2017.
13.
Lin S, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ. Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur. J. Orthop. Surg. Traumatol. 24(5), 797–803 (2014).
14.
Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury 37(6), 475–484 (2006).
15.
Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification. Injury 42(12), 1408–1415 (2011).
16.
Salem KH. Critical analysis of tibial fracture healing following unreamed nailing. Int. Orthop. 36(7), 1471–1477 (2012).
17.
Beaver R, Brinker MR, Barrack RL. An analysis of the actual cost of tibial nonunions. J. LA State Med. Soc. 149(6), 200–206 (1997).
18.
Hoekstra H, Smeets B, Metsemakers W-J, Spitz A-C, Nijs S. Economics of open tibial fractures: the pivotal role of length-of-stay and infection. Health Econ. Rev. 7(1), 32–32 (2017).
•• Compares total healthcare costs of open tibial fractures in patients with deep infection versus patients without infection.
Information & Authors
Information
Published In
Pages: 907 - 915
PubMed: 31172791
Copyright
© 2019 Future Medicine Ltd.
History
Received: 28 March 2019
Accepted: 16 May 2019
Published online: 7 June 2019
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Complications in type III open tibial shaft fractures treated with open reduction and internal fixation. (2019) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2019-0040
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Andrew D. Marten, Elizabeth Cho, Patrick Mazza, Carlo Eikani, Ashley E. Levack, Trends in open tibia fracture antibiotic prophylaxis, Archives of Orthopaedic and Trauma Surgery, 10.1007/s00402-025-05921-w, 145, 1, (2025).
- Xinling Zhang, Xin Yang, Yujie Chen, Guanhuier Wang, Pengbing Ding, Zhenmin Zhao, Hongsen Bi, Clinical study on orthopaedic treatment of chronic osteomyelitis with soft tissue defect in adults, International Wound Journal, 10.1111/iwj.13729, 19, 6, (1349-1356), (2021).
- Alexander T. Schade, Chetan Khatri, Henry Nwankwo, William Carlos, William J. Harrison, Andrew J. Metcalfe, The economic burden of open tibia fractures: A systematic review, Injury, 10.1016/j.injury.2021.02.022, 52, 6, (1251-1259), (2021).
- Hui Ye, Shufeng Lin, Junfeng Zhu, Lifeng Jiang, Clinical experience of biliary T tube of immobilization of peri-pin membrane in tibial Gustilo III fracture treated with vacuum sealant drainage combined with an external fixator, Medicine, 10.1097/MD.0000000000022846, 99, 43, (e22846), (2020).
