The service impact of failed locking plate fixation of distal tibial fractures: a service and financial evaluation at a major trauma centre

Introduction The surgical treatment of distal tibial fractures is challenging and controversial. Recently, locking plate fixation has become popular, but the outcomes of this treatment are mixed with complication rates as high as 50 % in the published literature. There are no reports specifically re...

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Veröffentlicht in:European journal of orthopaedic surgery & traumatology 2015-12, Vol.25 (8), p.1333-1342
Hauptverfasser: Kent, Michael, Mumith, Aadil, McEwan, Jo, Hancock, Nicholas
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Sprache:eng
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Zusammenfassung:Introduction The surgical treatment of distal tibial fractures is challenging and controversial. Recently, locking plate fixation has become popular, but the outcomes of this treatment are mixed with complication rates as high as 50 % in the published literature. There are no reports specifically relating to the financial and resource costs of failed treatment in the literature. Method Retrospective service analysis of patients who had undergone locking plate fixation of a distal third tibial fracture between 2008 and 2011 with at least 12 months follow-up. Rates of readmission, reoperation, bony union and infection were ascertained. The financial and resource (hospital stay and number of outpatient appointments) implications of failed treatment were calculated. Results Forty-two patients were identified. There were 31 type A fractures, one type B fracture and 10 type C fractures. Three injuries were open. Twenty patients were treated with minimally invasive percutaneous osteosynthesis (MIPO). The readmission and reoperation rates were 26 % ( n  = 11) and 19 % ( n  = 8), respectively. A total of 89 % of readmissions were due to infection. All patients had received appropriate antibiotic regimens. The average costs of successful and failed treatment were £5538 and £18,335, respectively. The average time to union was 24.5 weeks. The rate of non-union was 21 % ( n  = 9). The rate of infection was 28 % ( n  = 12), with all patients with open fracture incurring an infection. Tourniquet time had no effect on the incidence of complications. Smokers were more likely to incur a complication ( p  
ISSN:1633-8065
1432-1068
DOI:10.1007/s00590-015-1706-2