Civilian Ballistic Tibia Shaft Fractures Compared With Blunt Tibia Shaft Fractures: Open or Closed?

Prather, John C.; Montgomery, Tyler; Cone, Brent; Quade, Jonathan H; Fellows, Kenneth E.; Devine, T. L.; Spitler, Clay A.

doi:10.1097/bot.0000000000001911

Cited by 5 publications

(8 citation statements)

References 15 publications

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“…Abstract evaluation left 62 publications. After full-text examination of available studies, a total of 29 articles were kept for this review ( 10 , 24 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ). Among these only one article was found with the manual research ( 36 ).…”

Section: Resultsmentioning

confidence: 99%

“…( 56 ) RCS NS (II) 938 650 All bone fractures Prather et al . ( 57 ) RCS III 402 NS All (plateau + shaft + pilon) Wind et al . ( 58 ) RCS NS (II) 626– 626 All (plateau + shaft + pilon) ‡ When LOE was not specified in the study, both authors of this review evaluated it; their evaluation is shown in parentheses; * Study on 164 patients with ACS in the upper or lower limb, with or without a fracture; † Sub analysis on 59 tibial shaft fractures with acute compartment syndrome.…”

Section: Resultsmentioning

confidence: 99%

“…( 55 ), Meskey et al . ( 56 ), Prather et al ( 57 ) Sports injuries Menetrey et al . ( 27 ), McQueen et al .…”

Section: Resultsmentioning

confidence: 99%

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Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature

Morello,

Gamulin

2023

EFORT Open Reviews

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Introduction Acute compartment syndrome (ACS) is an orthopedic emergency that may lead to devastating sequelae. Diagnosis may be difficult. The aim of this systematic review is to identify clinical and radiological risk factors for ACS occurrence in tibial fractures. Methods PubMed® database was searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Additional articles were found by a manual research of selected references and authors’ known articles. Results The identification process individualized 2758 via database and 30 via other methods. After screening and eligibility assessment, 29 articles were included. Age, gender, occupation, comorbidities, medications, habits, polytrauma, multiple injuries, mechanism, sports, site, open vs closed, contiguous lesion, classification, and pattern were found to be related to ACS occurrence. Conclusions Younger age and male gender are strong independent risk factors in tibial plateau and shaft fractures. High-energy fractures, polytrauma, more proximal fractures and fractures with contiguous skeletal lesions are aggravating risk factors; higher AO/OTA and Schatzker classification types, increased displacement of the tibia relative to the femur, and increased tibial joint surface width are associated risk factors in tibial plateau fractures; higher AO Foundation/Orthopaedic Trauma Association classification types and subgroups and more proximal fractures within the diaphysis are associated risk factors in tibial shaft fracture. Open fractures do not prevent ACS occurrence. Increased fracture length is the only factor suggesting a higher risk of ACS in tibial pilon fractures. The presence of each independent predictor may have a cumulative effect increasing the risk of ACS occurrence.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature

Morello,

Gamulin

2023

EFORT Open Reviews

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“…There was a 9% rate of infection and a 30% rate of nonunion in the gunshot-induced subgroup. Prather et al [15] published a retrospective study that included 44 gunshot-induced tibia fractures. The infection rate was 9.1%, the nonunion rate was 11.4%, and the hardware failure rate was 4.7%.…”

Section: Discussionmentioning

confidence: 99%

Low-energy Gunshot-induced Tibia Fractures: What Proportion Develop Complications?

Lee

Brodke

Engel

et al. 2021

Clin Orthop Relat Res

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Background Gunshot injuries of the extremities are common in the United States, especially among people with nonfatal gunshot wounds. Controversy persists regarding the proper management for low-energy gunshot-induced fractures, likely stemming from varying reports on the likelihood of complications. There has yet to be published a study on a large cohort of patients with gunshot-induced tibia fractures on which to base our understanding of complications after this injury. Questions/purposes (1) What percentage of patients with low-energy gunshot-induced tibia fractures developed complications? (2) Was there an association between deep infection and fracture location, injury characteristics, debridement practices, or antibiotic use? Methods This was a multicenter retrospective study. Between January 2009 and December 2018, we saw 201 patients aged 16 years or older with a gunshot-induced fracture who underwent operative treatment; 2% (4 of 201) of those screened had inadequate clinical records, and 38% (76 of 201) of those screened had inadequate follow-up for inclusion. In all, 121 patients with more than 90 days of follow-up were included in the study. Nonunion was defined as a painful fracture with inadequate healing (fewer than three cortices of bridging bone) at 6 months after injury, resulting in revision surgery to achieve union. Deep infection was defined according to the confirmatory criteria of the Fracture-Related Infection Consensus Group. These results were assessed by a fellowship-trained orthopaedic trauma surgeon involved with the study. Complication proportions were tabulated. A Kaplan-Meier chart demonstrated presentations of deep infection by fracture location (proximal, shaft, or distal). Univariate statistics and multivariate Cox regression were used to examine the association between deep infection and fracture location, entry wound size, vascular injury, intravenous (IV) antibiotics in the emergency department (ED), deep and superficial debridement, the duration of postoperative IV antibiotics, and the use of topical antibiotics, while adjusting for age, race/ethnicity, smoking status, and BMI. A power analysis for the result of deep infection demonstrated that we would have had to observe a hazard ratio of 4.28 or greater for shaft versus proximal locations to detect statistically significant results at 80% power and alpha = 0.05. Results The overall complication proportion was 49% (59 of 121), with proportions of 14% (17 of 121) for infection, 27% (33 of 121) for wound complications, 20% (24 of 121) for nonunion, 9% (11 of 121) for hardware breakage, and 26% (31 of 121) for revision surgery. A positive association was present between deep infection and deep debridement (HR 5.51 [95% confidence interval 1.12 to 27.9]; p = 0.04). With the numbers available, we found no association between deep infection and fracture location, entry wound size, vascular injury, IV antibiotics in the ED, superficial debridement, the duration of postoperative IV antibiotics, and the use of topical antibiotics. Conclusion In this multicenter study, we found a higher risk of complications in operative gunshot-induced tibia fractures than prior studies have reported. Infection, in particular, was much more common than expected based on prior studies. Consequently, surgeons might consider adopting the general management principles for nongunshot-induced open tibia fractures with gunshot-induced fractures, such as the use of IV antibiotics both initially and after surgery. Further research is needed to test and validate these approaches. Level of Evidence Level IV, therapeutic study.

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“…Associated compartment syndrome must also be carefully evaluated for with concomitant neurologic/vascular injury. Ballistic tibia fractures have been found to have relatively high rates of compartment syndrome (up to 15.9%) compared with blunt mechanism injuries 62 and compared with other ballistic fracture locations 63 .…”

Section: Long-bone Injuriesmentioning

confidence: 99%

Firearm-Related Injuries—Wound Management, Stabilization, and Associated Injuries

et al. 2023

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Gun violence–related and firearm-related injuries are a public health crisis with increasing rates, particularly among younger demographics, in the United States despite a decline in incidence worldwide.There exists limited high-quality evidence to guide the management of firearm-related orthopaedic injuries.Associated injuries (i.e., neurological and vascular) are common in ballistic injuries to the extremity.Where indicated, low-energy orthopaedic injuries can be managed successfully with standard fixation and management strategies with similar complications to closed fractures.

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Civilian Ballistic Tibia Shaft Fractures Compared With Blunt Tibia Shaft Fractures: Open or Closed?

Cited by 5 publications

References 15 publications

Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature

Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature

Low-energy Gunshot-induced Tibia Fractures: What Proportion Develop Complications?

Firearm-Related Injuries—Wound Management, Stabilization, and Associated Injuries

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