"Navigating the tides of recovery": early vs. delayed osteosynthesis for closed tibia fractures complicated by acute compartment syndrome - an analysis of one hundred and three cases.

IF 2 3区医学 Q2 ORTHOPEDICS International Orthopaedics Pub Date : 2025-01-01 Epub Date: 2024-10-21 DOI:10.1007/s00264-024-06354-7

Mohamed Zackariya, Sanjana Nandakumar, Owais Ahmed, Devendra Agraharam, Ramesh Perumal, Dheenadhayalan Jayaramaraju, Rajasekaran Shanmuganathan

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Abstract

Purpose: In cases of closed tibia fractures with acute compartment syndrome (ACS), there is no established agreement on whether performing internal fixation at the time of closure or after healing of the fasciotomy wounds would affect the likelihood of non-union or infection risk. The study aims to compare fracture union rates, incidence of infection, and overall outcomes between early and delayed definitive fixation.

Methods: Retrospective analysis of closed tibia fractures (AO/OTA 41, 42) with ACS between 2010 and 2019 with a minimum two years follow-up. The patients were grouped into group-1 (early-definitive fixation group) and group-2 (delayed-definitive fixation group). The patients were further subdivided into - 1 A(early-plate osteosynthesis), 1B(early-intramedullary nail fixation), 2 A(delayed-plate osteosynthesis), and 2B(delayed-intramedullary nail fixation).

Results: Incidence of ACS in closed tibia fractures was 3.85%. Of the 103 patients included, the patients with plate fixation had a significantly higher union rate in the delayed group (100% vs. 91.66%; P = 0.0001). Similarly, among patients with nail fixation, a significantly higher union rate was seen in the delayed group (96.30% vs. 85.19%; P = 0.0016). The overall incidence of infection was 22.3% (23/103). Moreover, infection was higher in the early definitive fixation group (30.16% vs. 10%; P = 0.016).

Conclusion: With a lower incidence of infection and higher union rate among the delayed definitive fixation group, we propose to postpone the definitive fixation of closed tibia fractures complicated by ACS till the complete healing of fasciotomy wounds. This allows for adequate soft tissue healing and improvement in the biological environment of fracture, which boosts the chances of successful union and reduces infection risks.

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"驾驭恢复的浪潮"：急性室间隔综合征并发闭合性胫骨骨折的早期与延迟截骨术--对一百零三例病例的分析。

目的：对于伴有急性室间隔综合征（ACS）的闭合性胫骨骨折病例，在闭合时进行内固定还是在筋膜切开伤口愈合后进行内固定会影响骨折不愈合的可能性或感染风险，目前尚无定论。本研究旨在比较早期和延迟内固定的骨折愈合率、感染发生率和总体疗效：方法：回顾性分析 2010 年至 2019 年至少随访两年的 ACS 闭合性胫骨骨折（AO/OTA 41、42）。患者分为第一组（早期确定性固定组）和第二组（延迟确定性固定组）。患者又进一步细分为--1A（早期钢板骨整合术）、1B（早期髓内钉固定术）、2A（延迟钢板骨整合术）和2B（延迟髓内钉固定术）：结果：闭合性胫骨骨折的 ACS 发生率为 3.85%。在纳入的 103 名患者中，钢板固定患者的愈合率明显高于延迟组（100% 对 91.66%；P = 0.0001）。同样，在使用钢钉固定的患者中，延迟组的骨结合率明显更高（96.30% 对 85.19%；P = 0.0016）。感染的总发生率为 22.3%（23/103）。此外，感染率在早期明确固定组更高（30.16% vs. 10%；P = 0.016）：由于延迟最终固定组的感染发生率较低且愈合率较高，我们建议将合并 ACS 的闭合性胫骨骨折的最终固定推迟至筋膜切开伤口完全愈合后进行。这样可以使软组织充分愈合，改善骨折处的生物环境，从而提高成功愈合的几率，降低感染风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.