Introduction
Materials and methods
Statistical analysis
Ethics
Human and animal rights
Results
Treatment
Segment | ||||
---|---|---|---|---|
Proximal (N = 712) | Shaft (N = 417) | Distal (N = 242) | Total (N = 1371) | |
Non-surgical treatment | 352 | 62 | 75 | 489 |
Primary surgical treatment | 358 | 361 | 169 | 888 |
Planned secondary procedure | 97 | 83 | 122 | 302 |
Surgical treatment after failed non-surgical treatment* | 7 | 10 | 2 | 19 |
Re-operation due to non-union | 6 | 37 | 14 | 57 |
Re-operation due to malunion | 29 | 17 | 12 | 58 |
Re-operation due to infection | 32 | 20 | 14 | 66 |
Re-operation due to implant failure | 4 | 22 | 12 | 38 |
Re-operation due to patient discomfort | 42 | 62 | 14 | 118 |
Re-operation due to other reason | 40 | 63 | 23 | 126 |
Missed registrations | Total number of procedures | Completeness (%) | |
---|---|---|---|
Primary procedure | 12 | 1396 | 99.1 |
Planned secondary surgery | 34 | 302 | 88.7 |
Re-operation | 171 | 462 | 63.0 |
Total | 217 | 2160 | 90.0 |
AO/OTA class | Non-surgical | IM nail | Plate fixation | External fixation | Other surgical treatment* | Amputation | Total |
---|---|---|---|---|---|---|---|
Treatment, number of fractures (%) | |||||||
41-A1 | 38 (64) | 0 (0) | 1 (2) | 0 (0) | 20 (34) | 0 (0) | 59 |
41-A2 | 27 (49) | 1 (2) | 26 (47) | 1 (2) | 0 (0) | 0 (0) | 55 |
41-A3 | 1 (8) | 1 (8) | 10 (83) | 0 (0) | 0 (0) | 0 (0) | 12 |
41-B1 | 119 (66) | 1 (1) | 45 (25) | 0 (0) | 15 (8) | 0 (0) | 180 |
41-B2 | 107 (77) | 0 (0) | 24 (17) | 0 (0) | 8 (6) | 0 (0) | 139 |
41-B3 | 37 (29) | 0 (0) | 81 (64) | 0 (0) | 8 (6) | 0 (0) | 126 |
41-C1 | 9 (20) | 0 (0) | 33 (73) | 0 (0) | 3 (7) | 0 (0) | 45 |
41-C2 | 1 (5) | 0 (0) | 14 (74) | 2 (11) | 2 (11) | 0 (0) | 19 |
41-C3 | 2 (3) | 0 (0) | 52 (81) | 7 (11) | 1 (2) | 2 (3) | 64 |
Total 41 | 341 (49) | 3 (0.4) | 286 (41) | 10 (1) | 57 (8) | 2 (0.3) | 699 |
42-A1 | 15 (13) | 82 (73) | 12 (11) | 4 (4) | 0 (0) | 0 (0) | 113 |
42-A2 | 6 (12) | 38 (75) | 3 (6) | 1 (2) | 2 (4) | 1 (2) | 51 |
42-A3 | 19 (29) | 41 (62) | 2 (3) | 2 (3) | 2 (3) | 0 (0) | 66 |
42-B1 | 4 (10) | 31 (76) | 5 (12) | 1 (2) | 0 (0) | 0 (0) | 41 |
42-B2 | 2 (4) | 38 (76) | 9 (18) | 1 (2) | 0 (0) | 0 (0) | 50 |
42-B3 | 1 (4) | 14 (58) | 6 (25) | 2 (8) | 0 (0) | 1 (4) | 24 |
42-C1 | 0 (0) | 26 (84) | 5 (16) | 0 (0) | 0 (0) | 0 (0) | 31 |
42-C2 | 0 (0) | 14 (82) | 2 (12) | 1 (6) | 0 (0) | 0 (0) | 17 |
42-C3 | 1 (6) | 8 (44) | 6 (33) | 3 (17) | 0 (0) | 0 (0) | 18 |
Total 42 | 48 (12) | 292 (71) | 50 (12) | 15 (4) | 4 (1) | 2 (0.5) | 411 |
43-A1 | 30 (54) | 11 (20) | 15 (27) | 0 (0) | 0 (0) | 0 (0) | 56 |
43-A2 | 2 (29) | 1 (14) | 4 (57) | 0 (0) | 0 (0) | 0 (0) | 7 |
43-A3 | 3 (10) | 11 (37) | 13 (43) | 3 (10) | 0 (0) | 0 (0) | 30 |
43-B1 | 29 (57) | 0 (0) | 8 (16) | 1 (2) | 13 (25) | 0 (0) | 51 |
43-B2 | 1 (8) | 0 (0) | 9 (69) | 0 (0) | 3 (23) | 0 (0) | 13 |
43-B3 | 1 (8) | 0 (0) | 9 (69) | 0 (0) | 3 (23) | 0 (0) | 13 |
43-C1 | 2 (22) | 0 (0) | 7 (78) | 0 (0) | 0 (0) | 0 (0) | 9 |
43-C2 | 0 (0) | 2 (18) | 8 (73) | 1 (9) | 0 (0) | 0 (0) | 11 |
43-C3 | 0 (0) | 0 (0) | 44 (94) | 1 (2) | 2 (4) | 0 (0) | 47 |
Total 43 | 68 (29) | 25 (11) | 117 (49) | 6 (3) | 21 (9) | 0 (0) | 237 |
Not able to classify | 6 (50) | 0 (0) | 1 (8) | 0 (0) | 2 (17) | 3 (25) | 12 |
Total | 463 (34) | 320 (24) | 454 (33) | 31 (2) | 84 (6) | 7 (0.5) | 1359 |
AO/OTA | IM nail | Plate fixation | External fixation | Other fracture fixation* | Arthro-plasty | Arthro-desis | Amputation | Arthro-scopy | Correction osteotomy | Other soft- tissue surgery** | Removal of internal devices | Extraction of external fixation | Total number of procedures | Total number of reoperated fractures | Percentage reoperated fractures | Total number of surgically treated fractures |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of procedures | ||||||||||||||||
41-A1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 2 | 0 | 0 | 4 | 4 | 19.0 | 21 |
41-A2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 2 | 0 | 4 | 2 | 7.1 | 28 |
41-A3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 2 | 2 | 18.2 | 11 |
41-B1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 3 | 7 | 0 | 11 | 8 | 13.3 | 60 |
41-B2 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 1 | 0 | 8 | 0 | 11 | 9 | 28.1 | 32 |
41-B3 | 0 | 2 | 0 | 0 | 5 | 0 | 0 | 2 | 1 | 1 | 13 | 0 | 24 | 17 | 19.1 | 89 |
41-C1 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 4 | 1 | 3 | 8 | 0 | 19 | 10 | 27.8 | 36 |
41-C2 | 0 | 1 | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 5 | 0 | 10 | 6 | 33.3 | 18 |
41-C3 | 0 | 1 | 1 | 1 | 7 | 1 | 2 | 4 | 2 | 15 | 26 | 1 | 61 | 29 | 46.0 | 63 |
Total 41 | 0 | 5 | 4 | 3 | 14 | 1 | 2 | 13 | 5 | 28 | 70 | 1 | 146 | 87 | 24.3 | 358 |
42-A1 | 4 | 2 | 0 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 31 | 0 | 41 | 29 | 29.6 | 98 |
42-A2 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 12 | 1 | 14 | 10 | 22.2 | 45 |
42-A3 | 2 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 27 | 0 | 31 | 21 | 47.7 | 44 |
42-B1 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 2 | 13 | 0 | 18 | 13 | 35.1 | 37 |
42-B2 | 3 | 1 | 4 | 1 | 0 | 0 | 0 | 0 | 1 | 4 | 22 | 2 | 38 | 22 | 45.8 | 48 |
42-B3 | 1 | 0 | 2 | 0 | 0 | 0 | 2 | 0 | 1 | 3 | 8 | 0 | 17 | 8 | 36.4 | 22 |
42-C1 | 3 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 2 | 19 | 0 | 26 | 16 | 51.6 | 31 |
42-C2 | 0 | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 6 | 1 | 10 | 6 | 35.3 | 17 |
42-C3 | 1 | 2 | 0 | 2 | 0 | 0 | 0 | 0 | 1 | 2 | 7 | 0 | 15 | 8 | 47.1 | 17 |
Total 42 | 16 | 6 | 7 | 11 | 0 | 0 | 3 | 0 | 4 | 14 | 145 | 4 | 210 | 133 | 37.0 | 359 |
43-A1 | 0 | 1 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 5 | 0 | 9 | 6 | 25.0 | 24 |
43-A2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 2 | 2 | 40.0 | 5 |
43-A3 | 2 | 0 | 3 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 8 | 0 | 15 | 9 | 33.3 | 27 |
43-B1 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 5 | 0 | 8 | 3 | 13.6 | 22 |
43-B2 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 0 | 4 | 3 | 25.0 | 12 |
43-B3 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 0 | 2 | 0 | 6 | 3 | 25.0 | 12 |
43-C1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 14.3 | 7 |
43-C2 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3 | 0 | 5 | 3 | 27.3 | 11 |
43-C3 | 0 | 2 | 2 | 2 | 0 | 3 | 0 | 0 | 0 | 6 | 14 | 1 | 30 | 14 | 29.8 | 47 |
Total 43 | 2 | 6 | 7 | 6 | 0 | 4 | 0 | 0 | 3 | 8 | 43 | 1 | 80 | 44 | 26.3 | 167 |
Not able to classify | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 2 | 1 | 16.7 | 6 |
Total | 18 | 17 | 18 | 21 | 14 | 5 | 5 | 13 | 12 | 51 | 258 | 6 | 438 | 265 | 29.8 | 890 |
Re-operations
Non-union (%) | Malunion (%) | Infection (%) | Implant failure (%) | Patient discomfort (%) | Other reason (%) | Total re-operations (%) | |
---|---|---|---|---|---|---|---|
Proximal tibia | 0.6 | 4.7 | 3.9 | 0.8 | 9.1 | 9.1 | 24.0 |
Tibial shaft | 5.2 | 2.2 | 4.1 | 3.6 | 15.7 | 14.1 | 37.0 |
Distal tibial | 4.2 | 4.2 | 5.4 | 3.6 | 7.7 | 8.3 | 26.8 |
Total | 3.1 | 3.6 | 4.3 | 2.5 | 11.5 | 11 | 29.8 |
Non-union | Malunion | Infection | Implant failure | Patient discomfort | Other reason | Total number of re-operations | Total number of reoperated fractures | Percentage reoperated fractures | Total number of fractures | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Reason for re-operation | |||||||||||
Main treatment | Non-surgical | 0 | 3 | 1 | 0 | 2 | 0 | 6 | 6 | 2 | 344 |
IM nail | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 33 | 3 | |
Plate fixation | 3 | 16 | 20 | 3 | 31 | 24 | 97 | 65 | 23 | 286 | |
External fixation | 0 | 3 | 3 | 0 | 0 | 2 | 8 | 5 | 50 | 10 | |
Other surgical treatment* | 0 | 1 | 0 | 0 | 6 | 8 | 15 | 14 | 23 | 60 | |
Amputation | 0 | 0 | 1 | 0 | 0 | 2 | 3 | 2 | 67 | 3 | |
Total | 4 | 23 | 25 | 3 | 39 | 36 | 130 | 93 | 13 | 706 |
Non-union | Malunion | Infection | Implant failure | Patient discomfort | Other reason | Total number of re-operations | Total number of reoperated fractures | Percentage reoperated fractures | Total number of fractures | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Reason for re-operation | |||||||||||
Main treatment | Non-surgical | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 48 |
IM nail | 19 | 10 | 11 | 10 | 62 | 45 | 157 | 114 | 39 | 292 | |
Plate fixation | 7 | 0 | 7 | 5 | 0 | 10 | 29 | 20 | 39 | 51 | |
External fixation | 0 | 0 | 0 | 0 | 0 | 2 | 2 | 1 | 7 | 15 | |
Other surgical treatment* | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4 | |
Amputation | 0 | 0 | 2 | 0 | 0 | 3 | 5 | 3 | 75 | 4 | |
Total | 26 | 10 | 20 | 15 | 62 | 60 | 193 | 138 | 33 | 414 |
Discussion
Treatment
Re-operations
Non-union | Malunion | Infection | Implant failure | Patient discomfort | Other reason | Total number of re-operations | Total number of reoperated fractures | Percentage reoperated fractures | Total number of fractures | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Reason for re-operation | |||||||||||
Main treatment | Non-surgical | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 71 |
IM nail | 6 | 1 | 0 | 2 | 2 | 5 | 16 | 9 | 36 | 25 | |
Plate fixation | 2 | 8 | 11 | 5 | 8 | 12 | 46 | 33 | 28 | 117 | |
External fixation | 1 | 0 | 0 | 0 | 0 | 1 | 2 | 1 | 17 | 6 | |
Other surgical treatment* | 1 | 0 | 2 | 1 | 3 | 2 | 9 | 4 | 18 | 22 | |
Amputation | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Total | 11 | 9 | 13 | 8 | 13 | 20 | 74 | 48 | 20 | 241 |