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Outcomes of Patients With Large Versus Small Bone Defects in Open Tibia Fractures Treated With an Intramedullary Nail: A Descriptive Analysis of a Multicenter Retrospective Study.
Obremskey, William T; Tornetta, Paul; Luly, Jason; Morshed, Saam; O'Toole, Robert V; Hsu, Joseph R; Mitchell, Stuart L; Mackenzie, Ellen J; Frey, Katherine P; Castillo, Renan C; Bosse, Michael J; Scharfstein, Daniel O.
Afiliación
  • Obremskey WT; Vanderbilt University Medical Center, Nashville, TN.
  • Tornetta P; Boston University, Boston, MA.
  • Luly J; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • Morshed S; The University of California, San Francisco, San Francisco, CA.
  • O'Toole RV; R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
  • Hsu JR; Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC.
  • Mitchell SL; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • Mackenzie EJ; Johns Hopkins University School of Medicine, Baltimore, MD; and.
  • Frey KP; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • Castillo RC; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • Bosse MJ; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • Scharfstein DO; Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC.
J Orthop Trauma ; 36(8): 388-393, 2022 08 01.
Article en En | MEDLINE | ID: mdl-34962235
OBJECTIVES: To compare outcomes in patients with open tibia shaft fractures based on defect size. DESIGN: Retrospective review. SETTING: Eighteen trauma centers. POPULATION: The study included 132 patients with diaphyseal tibia bone defects >1 cm and ≥50% cortical loss treated with intramedullary nail. OUTCOMES: The primary outcome was number of secondary surgeries to promote healing (bone graft, revision fixation, or bone transport). Additional outcomes included occurrence of secondary surgeries (bone graft, infection, amputation, and flap failure) and proportion healed at one year. Results are compared by "radiographic apparent bone gap" of <2.5 or ≥2.5 cm. RESULTS: The estimated conditional probability of bone grafting within one year given graft-free at 90 days was 44% and 47% in the <2.5 cm and ≥2.5 cm groups, respectively. An estimated infection risk of 14% was observed in both groups [adjusted hazard ratio (HR) 0.98, 95% confidence interval (CI): 0.33-2.92], estimated amputation risk was 9% (<2.5 cm) and 4% (≥2.5 cm) (unadjusted HR 0.66, 95% CI: 0.13-3.29), and estimated flap failure risk (among those with flaps) was 10% and 13%, respectively (unadjusted HR 1.71, 95% CI: 0.24-12.25). There was no appreciable difference in the proportion healed at one year between defect sizes [adjusted HR: 1.07 (95% CI, 0.63-1.82)]. CONCLUSIONS: Larger size bone defects were not associated with higher number of secondary procedures to promote healing or a lower overall one-year healing rate. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Fracturas de la Tibia / Fijación Intramedular de Fracturas / Fracturas Abiertas Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Orthop Trauma Asunto de la revista: ORTOPEDIA / TRAUMATOLOGIA Año: 2022 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Fracturas de la Tibia / Fijación Intramedular de Fracturas / Fracturas Abiertas Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Orthop Trauma Asunto de la revista: ORTOPEDIA / TRAUMATOLOGIA Año: 2022 Tipo del documento: Article