Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4743-4752
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4743
Early complications of preoperative external traction fixation in the staged treatment of tibial fractures: A series of 402 cases
Jia-Zhao Yang, Wan-Bo Zhu, Liu-Bing Li, Qi-Rong Dong
Jia-Zhao Yang, Liu-Bing Li, Qi-Rong Dong, Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Jia-Zhao Yang, Department of Traumatic Orthopedics, The First Affiliated Hospital of USTC, Hefei 230000, Anhui Province, China
Wan-Bo Zhu, Department of Traumatic Orthopedics, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
Author contributions: Zhu WB and Yang JZ conceived and designed the study; Yang JZ collected the data and wrote the manuscript; Li LB and Dong QR read, revised, and approved the final manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of USTC (2020-P-061). As for this research, an optout of the informed consent, the information disclosure, and a negative opportunity are guaranteed in the Ethical approval.
Informed consent statement: All subjects participating in the study signed the informed consent statement form.
Conflict-of-interest statement: There is no conflict of interest issue related to this work.
Data sharing statement: Please contact author for data requests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Rong Dong, MD, Chief Doctor, Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou 215004, Jiangsu Province, China. dongqirong@suda.edu.cn
Received: July 10, 2020
Peer-review started: July 10, 2020
First decision: August 8, 2020
Revised: August 20, 2020
Accepted: September 15, 2020
Article in press: September 15, 2020
Published online: October 26, 2020
Processing time: 108 Days and 7.5 Hours
Abstract
BACKGROUND

Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment. However, the early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed.

AIM

To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.

METHODS

A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Data regarding the demographic information, Tscherne soft tissue injury, fracture site, entry point placement, and duration of traction were recorded. Procedure-related complications such as movement and sensation disorder, vessel injury, discharge, infection, loosening, and iatrogenic fractures were analyzed.

RESULTS

The mean patient age was 42.5 (18-71) years, and the mean duration of traction was 7.5 (0-26) d. In total, 19 (4.7%) patients presented with procedure-related complications, including technique-associated complications in 6 patients and nursing-associated complications in 13. Differences in the incidence of complications with respect to sex, affected side, soft tissue injury classification, and fracture sites were not observed. However, the number of complications due to hammer insertion was significantly reduced than those due to drill insertions (2.9% vs 7.4%).

CONCLUSION

We found a low incidence of early complications related to the fixation. Furthermore, the complications were not significantly associated with the severity of the soft tissue injury and fracture site. Although relatively rough and more likely to cause pain, the number of complications associated with hammer insertion was significantly smaller than that of complications associated with drill insertion.

Keywords: Tibial fracture, External fixation, Bone traction, Complications, Vessels injury, Nerve injury

Core Tip: The safety of external traction fixation has not been well studied. This study included 402 patients who underwent external traction fixation for high-energy tibial fractures. Overall incidence of complications was low (4.7%); vascular injury or compartmental syndrome was not noted. Complications of hammer insertions were significantly fewer than drill insertions.