Anterior knee dislocation with ipsilateral open tibial shaft fracture: a 5-year clinical follow-up of a professional athlete

ObjectivesDetermine the impact of infections on direct costs and healthcare resource use in England for patients undergoing intramedullary nailing (IMN) for tibial shaft fractures.DesignNon-concurrent cohort based on retrospectively collected data with 2-year follow-up.SettingEngland.ParticipantsThe study population included adult patients (≥18 years) in England with a diagnosis of tibial shaft fracture (International Classification of Diseases-10, S822) in the inpatient setting between May 2003 and June 2017 followed by a procedure for IMN for tibial shaft fracture within 30 days. Patient data were derived from the Clinical Practice Research Datalink linked to National Health Service Hospital Episode Statistics datasets.Primary independent variableInfection.Primary and secondary outcome measuresThe primary outcome was total inpatient costs from index stay admission through 1 year of follow-up. Secondary outcome included cumulative total healthcare costs, and resource utilisation at 30 days, 90 days, 1 year and 2 years.ResultsOverall, 805 patients met the inclusion criteria. At index inpatient stay, 3.7% had a post-IMN infection, rising to 11.7% at 1 year. One-year inpatient costs were 80% higher for patients with infection (p<0.001). Total costs were estimated to be £14 756 (95% CI £13 123 to £16 593) for patients with infection versus £8279 (95% CI £7946 to £8626). Length of stay (LOS), readmission and reoperation were the key drivers of healthcare costs (all p<0.001). After adjustment, LOS was higher by 109% (95% CI 62% to 169%), from 10.5 days to 21.9 days, for patients with infection. The odds of being readmitted or requiring reoperation were higher by 5.18 times (95% CI 3.01 to 9.13) and 2.47 times (95% CI 1.48 to 4.09), respectively, for patients with infection versus those without infection.ConclusionsPost-IMN infection significantly increases inpatient costs, LOS, readmissions and reoperations associated with tibial fracture fixation. Healthcare burden could be reduced through novel surgical site infection prevention strategies.

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PMD2 IMPACT OF INFECTION FOLLOWING INTRAMEDULLARY NAILING FOR A TIBIAL SHAFT FRACTURE-A REAL-WORLD STUDY WITH TWO YEARS FOLLOW-UP

Value in Health ◽

10.1016/j.jval.2019.04.1000 ◽

2019 ◽

Vol 22 ◽

pp. S216

Author(s):

C. Tong ◽

A.S. Chitnis ◽

T. Galvain ◽

K. Paparouni ◽

C.E. Holy ◽

...

Keyword(s):

Intramedullary Nailing ◽

Real World ◽

Shaft Fracture ◽

Tibial Shaft Fracture ◽

Tibial Shaft

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Anterior Knee Pain After Intramedullary Nailing of a Tibial Shaft Fracture: An Ultrasound Study of the Patellar Tendons of 36 Patients

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70395-x ◽

2006 ◽

Vol 2006 ◽

pp. 94-95

Author(s):

M.F. Swiontkowski

Keyword(s):

Intramedullary Nailing ◽

Knee Pain ◽

Anterior Knee Pain ◽

Shaft Fracture ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Ultrasound Study ◽

Anterior Knee

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Knee Dislocation with Ipsilateral Tibial Fracture Treated with an Intramedullary Locked Nail and Simultaneous Transtibial Tunnel Knee Ligament Reconstruction: A Case Report of Autografts and Limited Resources

The Surgery Journal ◽

10.1055/s-0040-1716685 ◽

2020 ◽

Vol 06 (03) ◽

pp. e160-e163

Author(s):

Túlio Vinícius de Oliveira Campos ◽

Marcelo Nacif Moraes ◽

Marco Antônio Percope de Andrade ◽

Robert C. Schenck ◽

Simon T. Donell

Keyword(s):

Ligament Reconstruction ◽

Tibial Fracture ◽

Trauma Surgery ◽

Knee Dislocation ◽

Shaft Fracture ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Knee Ligament ◽

Knee Ligament Reconstruction ◽

Ligamentous Reconstruction

AbstractKnee dislocations associated with ipsilateral tibial shaft fracture represent one of the most challenging injuries in trauma surgery. This injury occurs in only 2% of all tibial fractures in several series. With the use of intramedullary nail (IMN) of the tibia, current practice paraments suggest that transtibial tunnels should be avoided and ligamentous knee surgery be delayed until healing of the shaft fracture occurs. We report a novel case which was successfully managed by delayed IMN and multiligamentous transtibial posterior cruciate ligament (PCL) and posterolateral corner (PLC) autograft reconstructions. A 27-year-old male sustained a Gustilo-Anderson grade IIIa tibial shaft fracture and a Schenck IIIL knee dislocation (KD3L) in the ipsilateral knee. At 2 weeks, the patient was then taken back to the operating theater to undergo definitive bone fixation and ipsilateral simultaneous knee ligamentous reconstruction. The knee was stabilized by open reconstruction of the PCL under fluoroscopic control using an ipsilateral quadriceps autograft fixed with metallic interference screws. The PLC was reconstructed with ipsilateral semitendinosus autograft harvested through a separate 1.5-cm standard anteromedial incision using the technique described by Stannard et al. After graft fixation, the 90 degree posterior and posterolateral drawer and 0 and 30 degrees varus stress tests were negative. After 12 months follow-up, the patient had no complaints regarding pain or instability. The tibial fracture had healed and no knee axis deviation could be noted. The patient had returned to recreational low demand activities and motorcycle riding. Treatment of a combined tibial shaft fracture with an ipsilateral knee dislocation may be satisfactorily accomplished with an IMN for the tibia and transtibial tunnel fixation for knee ligament reconstruction allowing for a single rehabilitation course and a shorter recovery without having to use a third stage for knee ligamentous reconstruction.

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