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Clinical Outcomes Following Open Tibial Fractures in Latin America: A Multicenter Prospective Study
Madeline C MacKechnie1, Jose Eduardo Quintero2, Rafael Amadei3
1Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California.
Background:
The study compared health-related quality of life and fracture-healing based on the fixation method following isolated open tibial fractures in Latin America.
Methods:
A prospective study was conducted across 18 trauma centers in 8 countries. Adult patients with isolated open tibial diaphyseal fractures were included. The primary outcome measures were Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Health Survey (SF-12), which was administered at baseline and at follow-up at 6, 12, 26, and 52 weeks. The secondary outcome measure was the modified Radiographic Union Scale for Tibial Fractures (mRUST) score.
Results:
Of 422 patients, 389 had a baseline evaluation, with 352 (83.4% of the 422) completing at least 1 SF-12 follow-up and 309 (73.2%) completing at least 1 SF-12 follow-up and having radiographic follow-up within 1 year postoperatively. Initial definitive intramedullary nailing and external fixation or casting followed by staged intramedullary nailing were the most common fixation strategies. Both fixation methods were performed with similar frequency for Gustilo-Anderson (GA) Type-I and II injuries. The majority of GA Type-IIIA and IIIB/C fractures were treated with staged fixation. The presence of minimal or superficial contamination did not influence whether fractures were treated with initial intramedullary nailing or staged intramedullary nailing, whereas the presence of deep contamination was associated with staged management. For all GA types combined, initial definitive intramedullary nailing was associated with significantly higher PCS and MCS scores at 1 year than staged fixation. The mRUST scores at 1 year for all GA types combined were higher with initial definitive intramedullary nailing than with staged intramedullary nailing.
Conclusions:
Staged treatment remains common in Latin America, even for less severe injuries. Initial intramedullary nailing was associated with improved PCS and MCS scores and significantly higher mRUST scores relative to staged intramedullary nailing.
Level Of Evidence:
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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