Complication and Readmission Assessment of Fibular Intramedullary Nailing in the Context of Tibial Open Reduction Internal Fixation

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Tibial fractures, often accompanied by fibula fractures, are commonly treated with open reduction and internal fixation (ORIF) to restore lower limb function. Fibula fractures are sometimes managed with intramedullary (IM) nailing, which involves inserting a rod through a smaller percutaneous incision. This minimally invasive technique contrasts with ORIF, which requires a larger incision to secure the fibula with plates and screws. The smaller incision in fibula IM nailing may reduce soft tissue disruption and complications such as wound dehiscence, infection, and delayed healing, which are more frequent with ORIF. However, the optimal fixation method for fibula fractures in the context of tibial ORIF remains debated. This study uses the Nationwide Readmission Database (NRD) to compare complications and readmissions between the two surgical approaches. Methods: A retrospective cohort study was conducted using the NRD to examine 1,996 propensity-score matched patients who underwent tibia ORIF, with either fibular IM nailing or ORIF for associated fibula fractures. The incidence of total complications, including wound dehiscence, thromboembolism, cellulitis, surgical site infection, hardware failure, malunion, pseudoarthrosis, abscess formation, and the need for surgical debridement, were analyzed. Additionally, 30-day and 90-day readmission rates were compared between the two groups using chi-square tests or Fisher’s exact tests for statistical significance. Readmissions, both within 30 days and within 90 days, for specific complications were also analyzed. All results are in Table 1. Results: The study included 1,996 patients in both the IM and ORIF groups. The IM group demonstrated a significantly lower incidence of infectious complications (1.40% vs. 2.76%, p = 0.003) along with a lower incidence of 30-day readmission for a surgical site infection (0.6% vs 1.45%, p = 0.008). The IM group also demonstrated a significantly reduced rate of 31–90-day readmission for wound dehiscence (0.25% vs 0.85%, p = 0.01) and infection (0.4% vs. 1%, p < 0.023). Although the IM group demonstrated a greater rate of 30-day readmissions (11.72% vs. 9.62%, p = 0.031), no significant difference was observed in 90-day readmission rates (7.11% vs. 7.36%, p = 0.76). All results are shown in Table 1. Conclusion: Fibula intramedullary (IM) nailing, in the context of tibial open reduction and internal fixation (ORIF), demonstrates a favorable outcome profile with fewer surgical site complications. The significant reduction in wound dehiscence and infectious complications in the IM nailing group underscores its utility in cases where the risk of local, surgical-site complications is elevated. IM nailing may provide a promising alternative to ORIF, especially in patients with comorbidities or in clinical scenarios, such as polytrauma, where the risk of soft tissue complications is heightened. This minimally invasive approach offers potential benefits in improving recovery and minimizing complications in these high-risk populations.