Introduction

The objective of this study was to compare the rates of radiological and clinical complications after sequential treatment of a tibial shaft fracture by external fixation followed by secondary nailing with an early-stage conversion (C1S) versus a two-stage late conversion (C2S). The hypothesis of this work was that treatment with C1S does not increase the risk of surgical site infections compared to C2S, and allows faster healing with a lower malunion rate.

Material and methods

We carried out a retrospective and comparative study based on the files of the traumatology department of the Édouard Herriot University Hospital in Lyon. We reviewed the records of patients who presented with a Gustilo grade 1, 2 or 3a open tibial fracture treated with external fixation with conversion by intramedullary nailing within 6 months from January 2010 to December 2020. We assessed the occurrence of Surgical Site Infections (SSI), consolidation time, time until resumption of weight bearing and the malunion rate.

Results

Of the 55 patients included, a C1S procedure was performed in 25 cases (45.5%) versus 30 cases (54.5%) for C2S. No significant difference was found concerning the occurrence of SSI after intramedullary nailing between the two groups (p = 0.81). A significant difference was observed in terms of bone healing (p = 0.036) and the malunion rate (0.0013) in favor of nailing in one stage.

Discussion

The strategy of converting an open leg fracture early, in one stage (C1S), after initial external fixator placement allows for faster healing and weight bearing, while ensuring a lower malunion rate compared to that of a late two-stage conversion. In the absence of a scar at the time of intramedullary nailing, C1S does not increase the risk of surgical site infections. While the choice of a late and sequential two-stage operation is likely related to the surgeon's apprehension around conversion of an open leg fracture by intramedullary nailing, this study could promote the use of C1S in a greater number of situations.

Level of evidence

IV.

中文翻译：

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开放性胫骨干骨折的二次髓内钉。一期手术与二期手术的比较

介绍

本研究的目的是比较通过外固定继以早期转换 (C1S) 与两阶段晚期转换 (C2S) 二次内固定治疗胫骨干骨折序贯治疗后的放射学和临床并发症发生率。这项工作的假设是，与 C2S 相比，使用 C1S 治疗不会增加手术部位感染的风险，并且允许更快的愈合和更低的畸形愈合率。

材料与方法

我们根据里昂 Édouard Herriot 大学医院创伤科的档案进行了一项回顾性和比较研究。我们回顾了在 2010 年 1 月至 2020 年 12 月的 6 个月内接受外固定治疗并通过髓内钉转换的 Gustilo 1、2 或 3a 级开放性胫骨骨折患者的记录。我们评估了手术部位感染 (SSI) 的发生率、巩固时间、恢复负重时间和畸形愈合率。

结果

在纳入的 55 名患者中，25 例 (45.5%) 进行了 C1S 手术，而 30 例 (54.5%) 进行了 C2S。两组髓内钉术后 SSI 的发生率无显着差异 ( p  =  0.81)。在骨愈合 ( p  = 0.036) 和畸形愈合率 (0.0013)方面观察到显着差异 ，有利于在一个阶段进行钉钉。

讨论

在最初的外固定器放置后，在一个阶段 (C1S) 早期转换开放性腿部骨折的策略允许更快的愈合和负重，同时确保与晚期两阶段转换相比较低的畸形愈合率。在髓内钉时没有疤痕的情况下，C1S 不会增加手术部位感染的风险。虽然选择延迟和连续的两阶段手术可能与外科医生对通过髓内钉治疗开放性腿部骨折的担忧有关，但这项研究可以促进 C1S 在更多情况下的使用。

证据等级

四、