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Provisional plating had outcomes similar to standard reduction for closed tibia fractures
Patients who underwent provisional plating before intramedullary nail placement for treatment of complex, closed tibia fractures experienced similar risks for infection, nonunion and malunion compared with patients who underwent standard reduction prior to nail placement, according to results.
Reza Firoozabadi, MA, MD, and colleagues compared infection and nonunion rates of 40 patients who underwent provisional plating and 191 patients who underwent standard reduction for treatment of closed tibia fractures.
Results showed a significantly higher proportion of high-energy injury mechanisms, as well as a significantly higher proportion of diabetes among patients who underwent provisional plating vs. standard reduction. No differences were found between the two groups for rates of infection, nonunion or malunion. However, researchers noted similar rates of symptomatic implant removal between the two groups.
Despite the positive results when using provisional plating, Firoozabadi noted this technique should not be used for all closed tibia fractures “given the theoretical increased risk of having an infection every time an incision is made. Therefore, I advocate the use of provisional plating in the setting of complex tibia fractures that have cortical reads that allow for accurate reductions,” he told Healio.com/Orthopedics. “This will allow the surgeon to reliably restore and maintain length, alignment and rotation during the intramedullary nailing process.” — by Casey Tingle
Disclosures: Firoozabadi reports he receives an honorarium for teaching from AO North American and has been a consultant for Smith & Nephew. Please see the full study for a list of all other authors’ relevant financial disclosures.