Where Are We in 2022? A Summary of 11,000 Open Tibia Fractures Over 4 Decades.

ABSTRACT

OBJECTIVES: To determine the infection and nonunion rates for open tibia fracture treatment over the past 4 decades since the introduction of the Gustilo-Anderson (GA) open fracture classification. DATA SOURCES PubMed, Scopus, CINAHL, and Cochrane databases were reviewed using the PRISMA checklist for articles between 1977 and September 2018. STUDY SELECTION One hundred sixty-one articles meeting the following inclusion criteria English language, published between 1977 and 2018, reported infection rates, reported nonunion rates, and fractures classified by the GA open fracture criteria were selected. DATA EXTRACTION All articles were thoroughly evaluated to extract infection and nonunion data for open tibia fractures. DATA SYNTHESIS: Due to variability in the data reviewed, statistical evaluation could not be reliably done. RESULTS: 11,326 open tibia fractures were reported with 17% type I, 25.2% type II, 25.3% type IIIA, and 32.5% type IIIB/C. The average infection rate over 4 decades was 18.3%, with 24.3% superficial, 11.2% deep, and 14.7% pin tract. The infection rate by decade was 14% for 1977-1986, 16.2% for 1987-1996, 20.5% for 1997%-2006%, and 18.1% from 2007 to 2017. The overall nonunion rate was 14.1%. The nonunion rate was 13% for 1977-1986, 17% for 1987-1996, 12.8% for 1997%-2006%, and 12.3% for 2007-2017. CONCLUSIONS: This in-depth summary has demonstrated that the percentage rate for infections and nonunion has remained similar over the past 40 years. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.