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Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment.

Publication ,  Journal Article
Purcell, KF; Bergin, PF; Russell, GV; Graves, ML; Jones, LC; Spitler, CA
Published in: Journal of orthopaedic trauma
March 2022

To determine the outcomes of pilon and tibial shaft fractures with syndesmotic injuries compared with similar fractures without syndesmotic injury.Retrospective case-control study.Level 1 trauma center.All patients over a 5-year period (2012-2017) with tibial shaft or pilon fractures with a concomitant syndesmotic injury and a control group without a syndesmotic injury matched for age, OTA/AO fracture classification, and Gustilo-Anderson open fracture classification.Preoperative or intraoperative diagnosis of syndesmotic injury with reduction and fixation of both fracture and syndesmosis.Rates of deep infection, nonunion, unplanned reoperation, and amputation in patients with a combined syndesmotic injury and tibial shaft or pilon fracture versus those without a syndesmotic injury.A total of 30 patients, including 15 tibial shaft and 15 pilon fractures, were found to have associated syndesmotic injuries. The matched control group comprised 60 patients. The incidence of syndesmotic injury in all tibial shaft fractures was 2.3% and in all pilon fractures was 3.4%. The syndesmotic injury group had more neurologic injuries (23.3% vs. 8.3% P = 0.02), more vascular injuries not requiring repair (30% vs. 15%, P = 0.13), and a higher rate compartment syndrome (6.7% vs. 0%, P = 0.063). Segmental fibula fracture was significantly more common in patients with a syndesmotic injury (36.7% vs. 13.3%, P = 0.04). Fifty percent of the syndesmotic injury group underwent an unplanned reoperation with significantly more unplanned reoperations (50% vs. 27.5%, P = 0.04). The syndesmotic group had a significantly higher deep infection rate (26.7% vs. 8.3% P = 0.047) and higher rate of amputation (26.7% vs. 3.3% P = 0.002) while the nonunion rate was similar (17.4% vs. 16.7% P = 0.85).Although syndesmotic injuries with tibial shaft or pilon fractures are rare, they are a marker of a potentially limb-threatening injury. Limbs with this combined injury are at increased risk of deep infection, unplanned reoperation, and amputation. The presence of a segmental fibula fracture should raise clinical suspicion to evaluate for syndesmotic injury.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published In

Journal of orthopaedic trauma

DOI

EISSN

1531-2291

ISSN

0890-5339

Publication Date

March 2022

Volume

36

Issue

3

Start / End Page

157 / 162

Related Subject Headings

  • Treatment Outcome
  • Tibial Fractures
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Fractures, Open
  • Fracture Fixation, Internal
  • Case-Control Studies
  • Ankle Injuries
  • Ankle Fractures
 

Citation

APA
Chicago
ICMJE
MLA
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Purcell, K. F., Bergin, P. F., Russell, G. V., Graves, M. L., Jones, L. C., & Spitler, C. A. (2022). Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment. Journal of Orthopaedic Trauma, 36(3), 157–162. https://doi.org/10.1097/bot.0000000000002252
Purcell, Kevin F., Patrick F. Bergin, George V. Russell, Matt L. Graves, LaRita C. Jones, and Clay A. Spitler. “Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment.Journal of Orthopaedic Trauma 36, no. 3 (March 2022): 157–62. https://doi.org/10.1097/bot.0000000000002252.
Purcell KF, Bergin PF, Russell GV, Graves ML, Jones LC, Spitler CA. Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment. Journal of orthopaedic trauma. 2022 Mar;36(3):157–62.
Purcell, Kevin F., et al. “Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment.Journal of Orthopaedic Trauma, vol. 36, no. 3, Mar. 2022, pp. 157–62. Epmc, doi:10.1097/bot.0000000000002252.
Purcell KF, Bergin PF, Russell GV, Graves ML, Jones LC, Spitler CA. Tibial Shaft and Pilon Fractures With Associated Syndesmotic Injury: A Matched Cohort Assessment. Journal of orthopaedic trauma. 2022 Mar;36(3):157–162.

Published In

Journal of orthopaedic trauma

DOI

EISSN

1531-2291

ISSN

0890-5339

Publication Date

March 2022

Volume

36

Issue

3

Start / End Page

157 / 162

Related Subject Headings

  • Treatment Outcome
  • Tibial Fractures
  • Retrospective Studies
  • Orthopedics
  • Humans
  • Fractures, Open
  • Fracture Fixation, Internal
  • Case-Control Studies
  • Ankle Injuries
  • Ankle Fractures