Low-velocity ballistic tibia fractures are predisposed to complications and experience more unplanned reoperations

Ballistic trauma frequently results in tibia fractures. Despite the frequency of these injuries, there remains an incomplete characterization of ballistic fractures and their outcomes. The primary purpose of this study was to compare unplanned reoperation and fracture-related complication rates between blunt and ballistic tibia fractures.

This was a retrospective case control study. Patients from a single urban level 1 trauma center with low velocity ballistic injuries of the tibial shaft and distal tibia (AO/OTA 42 and 43) were identified and compared to a control cohort with closed blunt fractures. The primary outcome measures were unplanned reoperation rates and fracture-related complications.

Seventy-four patients met inclusion criteria and were compared to 74 patients in the control group. Twentyfive (33.7 %) patients in the study cohort required an unplanned reoperation versus 11 (14.9 %) in the control group (p = 0.013). Five (6.7 %) patients in the study cohort required soft tissue reconstruction to obtain coverage; deep infection developed in 13 (17.6 %) of the ballistic fractures versus none in the control group (p < 0.001). Eighteen (24.3 %) ballistic fractures went on to develop a nonunion versus just one (1.4 %) control (p=<0.001). Ballistic distal tibia fractures (AO/OTA 43) had higher rates of deep infection (36.4 % vs 9.6 %, p = 0.015) and unplanned reoperation (54.5 % vs 25 %, p = 0.018) compared to ballistic diaphyseal (AO/OTA 42) fracture patterns; with the numbers available for study, there was a similar rate of nonunion (36.4 % vs 19.2 %, p = 0.143).

This study suggests that low velocity ballistic tibia fractures have a higher incidence of unplanned reoperation and fracture-related complications than previously reported; more distal fracture location was associated with deep infection and unplanned reoperation. Surgeons managing ballistic fractures of the tibia should be cognizant of these differences and factor them into their clinical decision making, especially when managing fractures of the distal tibia or plafond.