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Conservative treatment of tibial shaft fractures found functional and cost-effective
Though patients will miss more time at work and undergo more follow-ups, they will heal completely.
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The conservative treatment of tibial shaft fractures should not be written off as a viable solution, according to investigators from India.
Findings reinforcing that claim were presented by Vineet Batta, MD, at the British Orthopaedic Association 2009 Congress.
Batta’s team aimed to look at the conservative treatment of tibial shaft fractures as a more cost-effective and yet functional procedure.
“For the last 10 to 15 years, there has been a change … people have started saying that operative treatment gives much better results,” Batta said. The idea of operative treatment being a better solution means little to “orthopedic surgeons in the developing world, because most of these studies were done in the West, in publicly-funded setups with state-of-the-art technology leading to extremely low rates of infection,” he continued.
Study parameters and results
Batta’s study compared the results and cost-effectiveness of intramedullary nailing (IMN) vs. cast bracing for closed and type 1 open displaced tibial shaft fractures. In the study, 68 consecutive patients were alternately treated with cast bracing or IMN for 5 years and were followed for an average of 6.3 years.
Batta reported no statistical difference in the final functional outcome between the groups.
Though IMN patients were reported as having to take less time off of work, having fewer outpatient visits, less limb-length discrepancy and less residual deformity, the cast bracing group suffered no deep infections as compared to 6% in the IMN group. Additionally, the cost of cast bracing treatment was less than half of that incurred by the IMN group.
Most importantly, Batta said, “At an average follow-up of 6.3 years, there was no statistically significant difference in the final functional outcome of either group in terms of gait and all other criteria.”
The reduced cost, similar results and smaller risk of deep infections involved with cast bracing are important factors to patients outside of the western world, Batta said. Money and sanitary conditions are greater concerns elsewhere.
Applicable to everyone
According to Batta, many of the patients in the study were farmers who had familial help to handle manual labor around the house and crops during their recovery period, slightly lessening the burden of missed time in the field. – by Robert Press
Reference:
- Batta V, Dwyer A, Jeevan P, et al. Let us not write off conservative treatment of tibial shaft fractures. Presented at the British Orthopaedic Association 2009 Congress. Sept. 16-18, 2009. Manchester.
- Vineet Batta, MD, can be reached at battavineet@yahoo.com.
I think this is a nice paper. It adds to the evidence that, long-term, you can get good results. That is useful to tell a patient in the Western world who is very against the operation that, actually, long-term you will do fine. You will have more time off of work and more follow-up visits but fewer complications, and that is nice to be able to say.
– David M. Hahn, FRCS
Nottingham
University Hospital
Nottingham, U.K.