Early versus delayed operative management of closed tibial fractures

Fractures of the tibial shaft ale the most common long bone fractures. Oper ative treatment of isolated closed tibial shaft fractures frequently is del ayed in favor of treatment of life threatening injuries. A retrospective ch art review of 200 tibial fractures was performed. These injuries were manag ed by two surgeons at a Level 1 trauma center between 1989 and 1996, Strict inclusion criteria identified 54 patients with an isolated closed tibial f racture. Postoperative hospital stay and complication rates were recorded. At a mean followup of 3.6 years, a quality of life questionnaire was admini stered via telephone calls to these patients. Two patient groups were ident ified: Group 1, 21 patients (< 12-hour surgical delay); and Group 2, 33 pat ients (> 12-hour surgical delay). Both groups were similar for baseline cha racteristics. Group 2 patients remained an extra 4.6 days in the hospital. A Kaplan-Meier analysis revealed that by the eighth postoperative day, all Group 1 patients were discharged from the hospital, whereas 47.8% of Group 2 patients remained in the hospital, Plate fixation was associated with a g reater incidence of complications when compared with intramedullary nail in ternal fixation, Complication rates were significantly greater in the delay ed surgical group. A multiple regression analysis revealed that surgical de lay and postoperative complications accounted for 35% of the total variance in postoperative hospital stay. Time to surgical treatment was not prognos tic of long term quality of life, Surgical delay results in longer postoper ative hospital stays, greater complication rates, and increased total cost to the health care system.