Does Provisional Plating of Closed Tibia Fractures Have Higher Complication Rates?

OBJECTIVES

To compare infection and nonunion rates after provisional plating (PP) with standard reduction (SR) techniques for closed tibia fractures treated with an intramedullary nail.

DESIGN

Retrospective comparative study.

SETTING

Level 1 academic trauma center.

PATIENTS/

PARTICIPANTS

Of the 348 closed tibia fractures (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 42) treated using an intramedullary nail from January 2007 through June 2015, 231 (40 PP and 191 SR) patients met inclusion/exclusion criteria.

INTERVENTION: The patients received either a provisional plate or an SR before intramedullary nail placement.

MAIN OUTCOME MEASUREMENT: Infection and nonunion.

RESULTS

The PP cohort had a significantly higher proportion of high-energy injury mechanism and a significantly higher proportion of diabetes than the SR cohort. We were unable to demonstrate a difference in rates of infection [PP cohort (1/40, 2.5%) vs. SR cohort (6/191, 3.1%), P = 1.0], nonunion [PP cohort (3/40, 7.5%) vs. SR cohort (9/191, 4.7%), P = 0.44], or malunion [PP cohort (0/40, 0%) vs. SR cohort (8/191, 4.2%), P = 0.36]. Symptomatic implant removal was similar between the 2 groups [PP cohort (4/40, 10%) vs. SR cohort (27/191, 14%), P = 0.61].

CONCLUSION

PP can be used for complex, closed tibia fractures without an increased risk of infection, nonunion, and malunion compared with standard closed reduction techniques.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.