Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications

Weber, Christian David; Hildebrand, Frank; Kobbe, Philipp; Lefering, Rolf; Sellei, Richard Martin; Pape, Hans-Christian; Dgu, TraumaRegister

doi:10.1007/s00068-018-0916-9

Cited by 49 publications

(51 citation statements)

References 51 publications

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“…The PPV of the diagnosis trochanteric fracture was 92% and of subtrochanteric fracture 83%, ie, results that are comparable to our numbers. 7 9,10 These differences could be due to the fact that patient populations from trauma centers are likely to comprise a larger part of complicated cases. By analyzing moderate and severe injuries separately, we saw that the validity for the diagnosis was higher among severe injuries.…”

Section: Discussionmentioning

confidence: 99%

<p>Diagnosis of Open Tibial Fracture Showed High Positive Predictive Value in the Swedish National Patient Register</p>

Tampe¹,

Frank²,

Weiss³

et al. 2020

CLEP

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Introduction: The Swedish National Patient Register was validated only for a few diagnoses in the field of trauma. In this study, we calculated the positive predictive values (PPV) of the diagnosis of open tibial fracture and corresponding E-codes (cause of injury). Patients and Methods: Out of 2845 cases from a 10-year period (2007-2016), a random sample of 300 cases was selected for review of medical records. The accuracy of the diagnosis and cause of injury was calculated and presented as PPV. We divided the study population into two subgroups (moderate and severe injury) that were analyzed separately. Severe injury was defined as when a patient had an amputation and/or reconstructive surgical procedures, indicated by corresponding ICD-codes. Results: The PPV of the diagnosis of open tibial fracture was 87% (95% CI: 86-88%) overall, 86% (95% CI: 79-91%) for moderate injuries and 96% (95% CI: 91-98%) for severe injuries. The PPV for E-codes was 74% (95% CI: 65-81%). The majority of injuries were caused by falls (47%) or transport accidents (38%). Most of these injuries were caused by high-energy trauma (60%). Conclusion: The PPV of the diagnosis of open tibial fracture in the Swedish National Patient Register is high (87%). The PPV of E-codes was lower (79%). The results imply that the register is well suited for healthcare evaluation and research purposes regarding trauma diagnoses. Most open tibial fractures are high-energy injuries.

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Section: Discussionmentioning

confidence: 99%

<p>Diagnosis of Open Tibial Fracture Showed High Positive Predictive Value in the Swedish National Patient Register</p>

Tampe¹,

Frank²,

Weiss³

et al. 2020

CLEP

View full text Add to dashboard Cite

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“…Grade 3 open fracture is a high-energy injury, which may threaten the limb and occasionally even the life of the patient 1,2 . The tibia is the commonest site for open fractures 3 with grade 3B/C injuries being complicated by degloving of soft tissues, with gross contamination, possible vascular injuries, and often with poor outcomes. The management decision oscillates between limb salvage and amputation 4 , where many authors [5][6][7][8][9] project a dismal outcome due to the medium and long-term problems with soft-tissue cover, infection, and union, ending with serious disability.…”

Section: Introductionmentioning

confidence: 99%

Single-stage "Fix and Flap" gives Good Outcomes in Grade 3B/C Open Tibial Fractures: A Prospective Study

Singh¹,

Dhillon²,

Ss³

2020

Malays Orthop J

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Introduction:Grade 3B/C open tibial fractures with grossly contaminated degloving injuries have poor outcomes, with or without vascular injuries. Treatment decision oscillates between limb salvage and amputation. The standard protocol of repeated debridement and delayed wound cover is a challenge in developing countries due to overcrowded emergencies and limited operating room availability. We present results of our modified protocol involving primary stabilisation with external fixation and immediate wound cover as an aggressive modality of treatment. Material and Methods: Thirty-three patients with severe open tibial shaft fractures were managed using a standardised protocol of emergent debridement, external fixation and immediate wound cover with free distant/local rotational muscle flaps and fasciocutaneous flaps, and with vascular repair in Grade 3C fractures. Intra-articular fractures were excluded. Patients were followed for a minimum of three years, with an assessment of clinical, radiological and functional outcomes. Results: Wound cover was achieved with 24 distant free muscle flaps, four local rotational muscle flaps and five fasciocutaneous flaps. All fractures united with an average time to union of 40.3 weeks (16-88). Fifteen patients (45.4%) underwent only a single major surgery using primary definitive external fixation. Deep infection was seen in four patients (12.1%). Nineteen patients had excellent to good outcomes, six were fair, and eight were poor. Conclusion: "Fix and Flap" in the same sitting, using immediate wound cover and external fixation, has given good results in our hands despite the delayed presentation, the neurovascular deficit and the degloving injury. This may be a better management strategy in overcrowded tertiary care centres of developing countries, with a single surgical procedure in almost half the cases.

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“…Open fractures always result from high-energy injury and severe one is often associated with unpredictable complications and disabilities which could lead to a signi cant higher long-term morbidity and mortality even treated and managed by sophisticated orthopedics trauma surgeon [1][2][3] [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…The plates are frequently used for fractures extended to the joints and nails are for extra-articular fractures. Moreover, currently IMNs are also used for fractures with a limited extension to the joint and indications for their use is extending as they are better choices particularly for open fractures [1,[4][5][6]. Complex open distal tibial fractures are always associated with severe soft tissue injury, sometimes even with the onset of segmental bone defect.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

Xu¹,

Ren²,

Zhong³

et al. 2020

Preprint

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Background To analyze the clinical characteristic and economic of intramedullary nailing versus locking compression plate for the treatment of open distal tibial fractures.Methods A retrospective analysis was conducted by enrolling patients with open distal tibial fractures who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department，Xi’an Honghui Hospital from January 2016 to January 2019. The collected clinical materials and data included gender, age, injury mechanism, smoke and alcohol, comorbidity disease, Gustilo classification, days before operation, final treatment option, surgical duration, intraoperative bleeding loss, length of stay, complications, Johner-Wruhs criteria, total cost within 1 year after surgery (including hospitalization expenses and postoperative rehabilitation or follow-up expenses). All the patients were divided into two groups based on the final treatment options: Group IMN(intramedullary nailing) and Group LCP(locking compression plate). Cost data for each case within 1 year after surgery were analyzed for the cost-effectiveness ratio (CER)and incremental cost-effectiveness ratio (ICER) of IMN versus LCP.Results 49 consecutive cases were enrolled including 28 cases of Group IMN and 21 cases of Group LCP with the excellent and good rate of 82.1% (23 cases) and 85.7% (18 cases) respectively based on Johner-Wruhs criteria. The surgical duration (p=0.017) and intraoperative bleeding loss(p=0.046) were significantly lower in Group IMN than in Group LCP. Total cost within 1 year after surgery(p=0.048) was also less in Group IMN（126435.90±39093.98 CNY）than in Group LCP（147834.60±56821.12 CNY）. No statistically significant difference was discovered on the excellent and good rate of Johner-Wruhs criteria between the two groups(p＞0.05). The average cost for every 1% of excellent and good rate was 1540.02 CNY in Group IMN and 1725.02 CNY in Group LCP. Each 1% increasing of excellent and good rate cost 5944.08 CNY more in Group LCP compared with Group IMN.Conclusions Both the IMN and LCP could provide a satisfactory outcome for open distal tibial fractures. However the IMN was a more cost-effective management than LCP when the economic analysis was included.

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Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications

Cited by 49 publications

References 51 publications

<p>Diagnosis of Open Tibial Fracture Showed High Positive Predictive Value in the Swedish National Patient Register</p>

<p>Diagnosis of Open Tibial Fracture Showed High Positive Predictive Value in the Swedish National Patient Register</p>

Single-stage "Fix and Flap" gives Good Outcomes in Grade 3B/C Open Tibial Fractures: A Prospective Study

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

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