Hulskamp, C.B.P. (Casper Bernard Pieter) (2013) Segmentale tibiafracturen. Een vergelijking van twee behandelingen bij volwassenen. thesis, Medicine.
![[img]](https://umcg.studenttheses.ub.rug.nl/style/images/fileicons/text.png) |
Text
HulskampC.pdf Restricted to Registered users only Download (1MB) |
Abstract
Introduction: A segmental tibial fracture is a rare but difficult result of a high-energetic trauma. These patients are mostly multi-trauma patients, with extended skin lesions, tissue- and vessel damage, complicating the healing process. Healing of the fracture is even more difficult in open skin fractures with a high risk of infection. Segmental tibial fractures can be treated like single fractures by fixating the bone with: a casket, external fixation (fixateur externe), an intramedullar nail or a percutaneous plate. Untill now, there has not been evidence showing which of the methods is best. Publications of research found describe case-reports about a single method and a conclusive comparison has not yet been made. This research focuses on comparing both intramedullary nailing and percutaneous plating. Patients and methods: This research is a retrospective cohort research. From January 2000 until September 2012 all data from patients with a segmental tibial fracture, classified by the Orthopeadic Trauma Association (OTA)/AO Müller classification as 42-C2, from both 'Hospital Mutual de Seguridad' and 'Hospital de Trabajador' in Santiago, Chili, were included in this research. Patient files were used to gather information about: sex, age, consolidation time, complications (infection, delayed union, non union, mal union), extra surgery needed for the segmental fracture, open fracture (yes/no and classification according to Gustillo-Anderson), associated trauma and surgery. A survival analysis has been made on the consolidation time measured in weeks. Also Kaplan-Meyer curves were made and analyzed through a log-rank test. The relative risk was calculated through a semiparametric cox-regression. The hazard ratio for proportions was calculated, with a confidence interval of 95% with and a level of significance of 5%. Percentages of the complications 'non-union' and 'infection' were compared with a Fisher's exact test with a level of significance of 5%. All data was analyzed with statistical software STATA® v.11.1. Results: The most important result of this research is a significantly better consolidation time for the patients treated with the percutaneous plate (P=0,03). The average time to consolidation for this group was 29 weeks (range 17-52 weeks), in the group treated with the intramedullary nail 35 weeks (range 12-93). The group treated with the intramedullary nail resulted in significantly more non-unions (P=0,008). Furthermore this group had almost double the amount of open fracture (61,5% vs. 16,7% in the other group). No significant difference in the amount of fractures with infection was found between the both treatments. Discussion: Treatment with a percutaneous plate resulted in a significant faster time of consolidation and less complications. This then might conclude this treatment provides best results for segmental fractures of the tibia. Unfortunately the big difference in open fractures between the two groups dictates this is not a fair comparison. An open fracture has an imporant negative influence on healing of the tissue at the fracture side and this results in worse conditions for the bone to heal. Concluding one treatment would be better than the other in these conditions is incorrect. Future research should focus on a better comparable population and should be performed in a prospective multi-center research.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Wendt, Dr. K.W. |
| Supervisor name: | Muñoz, Dr. Luis Alberto Bahamonde and traumatologie/orthopedie and Hospital Clinico Universidad de Chile and Santiago, Chili |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1596 |
Actions (login required)
 |
View Item |