Reoperation rate in diaphyseal tibia fractures

Background: Tibia fractures often require secondary surgery to achieve union. Reoperation is an objective outcome measure that is clinically relevant to the patients and treating doctors. This study determined the complication and reoperation rates for diaphyseal tibia fractures and identified variables predictive of reoperation. Methods: One-hundred and sixty-seven patients with 175 consecutive tibia shaft fractures (Association for the Study of Internal Fixation classification 42) presenting between July 2000 and June 2003 were included in the study. There were 4 deaths and 12 patients lost to follow up. The remaining 151 patients (159 fractures) were reviewed at a minimum of 6 months post-injury for the main outcome measures; union and reoperation. Univariate and multivariate analyses by logistic regression were used to identify any relationship between revision surgery and fracture classification, grade of the soft-tissue injury, mechanism of injury, age, sex, and treating surgeon. Results: The overall reoperation rate was 35.8% (57/159) with 13.2% (21/159) tibiae requiring minor revision surgery and 22.6% (36/159) tibiae requiring major revision surgery. Thirteen (8.2%) patients underwent major revision surgery specifically for non-union. The fracture classification and the Gustilo grade of soft-tissue injury were significant predictors of revision surgery overall, and of major revision surgery. Conclusions: Tibial shaft fractures have a high revision rate as a consequence of non-union and infection. Revision surgery is best predicted by the fracture classification and the severity of the soft-tissue injury. This information is important for patient information and clinical decision making.