[Are complications following plate osteosynthesis of the lower diaphyseal shaft unavoidable?]

Metal plate osteosynthesis of the tibial shaft is a difficult and technically demanding procedure. When strict indications are carefully observed very good results can be obtained, but it must be pointed out that numerous complications may also be entailed. Between 1977 and 1987 a total of 447 operatively treated diaphyseal fractures of the lower limb were included in two studies of metal plate osteosynthesis. Whereas in study I (1977-1980) method-associated complications were detected in 24 cases out of a total of 87 (27.6%), including 9 cases of osteomyelitis alone, the second study, performed between 1981 and 1987 (126 cases), showed that the frequency of complications was drastically lower, with 18 cases (14.3%) even including minor complications. This is especially striking when it is borne in mind that osteomyelitis occurred in 2 cases only (1.6%) in study II. The lower number of complications is reflected by considerably shorter hospital stays, shorter periods of disability, and a lower number of disability pensions. The decline in the frequency of serious complications was primarily due to a decrease in the proportion of patients with open fractures treated with plate osteosynthesis from nearly 50% to 19%. In accordance with other publications it was confirmed that damage to the soft tissues of the lower limb is the decisive factor in postoperative and inflammatory complications. The results obtained show that plate osteosynthesis of diaphyseal fractures of the lower limb, particularly in cases of first- or second-degree closed fractures, involves only a low risk of complications. When indications are strictly observed, this method can be thoroughly recommended, especially for B group (wedge) fractures.(ABSTRACT TRUNCATED AT 250 WORDS)