Clinical Outcomes Following Open Tibial Fractures in Latin America: A Multicenter Prospective Study.

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Health Outcomes Research

Background:

• Open tibial fractures present significant challenges in achieving optimal health-related quality of life and fracture healing.
• Fixation methods play a crucial role in the recovery process for these complex injuries.
• Understanding regional variations in treatment and outcomes is vital for improving care in Latin America.

Purpose of the Study:

• To compare health-related quality of life (HRQoL) and fracture healing outcomes based on different fixation methods for isolated open tibial fractures.
• To evaluate the impact of initial definitive intramedullary nailing versus staged fixation strategies.
• To assess patient-reported outcomes using the SF-12 and radiographic union using the mRUST score.

Main Methods:

• A prospective study involving 422 adult patients with isolated open tibial diaphyseal fractures across 18 trauma centers in 8 Latin American countries.
• Primary outcomes included Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-12, assessed at baseline and multiple follow-up points up to 52 weeks.
• Secondary outcome was the modified Radiographic Union Scale for Tibial Fractures (mRUST) score, evaluated radiographically within 1 year postoperatively.

Main Results:

• Initial definitive intramedullary nailing was associated with significantly higher PCS and MCS scores at 1 year compared to staged fixation across all Gustilo-Anderson (GA) fracture types.
• Radiographic union scores (mRUST) at 1 year were significantly higher with initial definitive intramedullary nailing than with staged fixation.
• Deep contamination strongly correlated with the use of staged fixation, while minimal/superficial contamination did not influence the choice between initial or staged intramedullary nailing.

Conclusions:

• Initial intramedullary nailing demonstrates superior outcomes in terms of HRQoL (PCS/MCS scores) and fracture healing (mRUST scores) compared to staged fixation for open tibial fractures.
• Staged treatment remains a prevalent strategy in Latin America, even for less severe open tibial fractures.
• The findings support the consideration of initial definitive intramedullary nailing as a potentially more effective treatment for improving patient outcomes in open tibial fractures.