Abstract
BackgroundOsseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft - tissue and vascular supply in this area. Postoperative complications are frequent, and according to the literature, open reduction and plate fixation is thought to be associated with higher complication rates. The objective of this study was to evaluate the most common postoperative complications following intramedullary nailing or plate osteosynthesis of distal lower leg injuries with a focus on combined tibio-fibular fractures. The outcomes of patients with and without complications associated the two surgical techniques were compared.MethodsDuring a 5-year period, all surgically treated distal tibiofibular fractures were retrospectively collected from the clinical database and were evaluated for the presence of postoperative complications which included compartment syndrome, wound infection, delayed union and non-union, synostosis and rotational malalignment. Postoperative complications were reviewed and correlated with patient risk factors.ResultsA total of 199 patients were included in the study, and 75 complications were reported. The majority of complications were associated with closed fracture types treated with intramedullary nailing, delayed union being the most frequent. For open fractures, surgical treatment with plate fixation had a complication rate of 12% compared with 25% after intramedullary nailing.DiscussionIn general, distal lower leg fractures are associated with a high risk of postoperative complications. Distal diaphyseal tibial fractures that have been treated with intramedullary nailing devices have a higher risk of delayed union or non - union.ConclusionPlate fixation in distal metaphyseal fractures has a higher risk of problems related to wound healing and postoperative wound infections.
Highlights
Osseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft - tissue and vascular supply in this area
The objective of this study was to compare postoperative complications in distal lower leg fractures managed with intramedullary nailing systems with those managed with plate osteosynthesis
This study focused on the correlation between outcomes and surgical management, patient risk factors and complication rates, as well as open fracture types and their complication rates
Summary
Osseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft - tissue and vascular supply in this area. The objective of this study was to evaluate the most common postoperative complications following intramedullary nailing or plate osteosynthesis of distal lower leg injuries with a focus on combined tibio-fibular fractures. The outcomes of patients with and without complications associated the two surgical techniques were compared. Surgical management and postoperative care can be challenging, primarily because osseous and wound healing of the distal lower leg can be critical. Surgical treatment of distal tibiofibular fractures with intramedullary nailing (IMN) is the preferred method of repair [5], even in very distal fractures [6].
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