Analysis of complications and clinical outcomes in the treatment of segmental tibial fractures according to the method of internal fixation

Abstract

We compared and analysed not only the clinical and radiological results of surgery but also the complications according to the definitive fixation method. We retrospectively reviewed the medical records and radiographs of all segmental tibial fracture patients treated with either intramedullary nailing or minimally invasive plate osteosynthesis between 2010 and 2017. We enrolled 69 patients. The patients' mean age was 48.6 years (25-74). Forty-nine patients had open fractures (Type I, 20; Type II, 9; Type III, 20) and six had acute compartment syndrome. The initial stabilisation method was intramedullary nailing in 28 patients (40.6%). The time to definitive fixation was longer in the minimally invasive plate osteosynthesis group (mean, 8.8 days; range, 0-27) than that in the intramedullary nailing group (mean, 3.9 days; range, 0-35), with a statistically significant difference (p=0.001). Thirteen patients developed nonunion (five with minimally invasive plate osteosynthesis and eight with intramedullary nailing, p=0.076). Complications were noted in 18 patients (26.1%), including five with infection. There was no significant difference in the clinical and radiological outcomes according to the definitive fixation method. A multivariate logistic regression analysis indicated that age (odds ratio, 1.112; 95% confidence interval, 1.022-1.210; p=0.013) and smoking (odds ratio, 13.976; 95% confidence interval, 1.599-122.150; p=0.017) correlated with the occurrence of complications. The results of our study suggest that if soft-tissue handling and restoration of bony alignment are successful, both intramedullary nailing and minimally invasive plate osteosynthesis will be effective treatment methods for segmental tibial fractures.