JBJS - 2026-07-15 - Journal Article; Multicenter Study
Clinical Outcomes Following Open Tibial Fractures in Latin America: A Multicenter Prospective Study.
MacKechnie MC, Quintero JE, Amadei R, Rio M, Shearer DW, Bidolegui F, Madrigal R, González Torres JC, Segovia J, Salazar Del Villar M, Vega MO, Morshed S, Kohn MA, Miclau T, the ACTUAR Study Group
Topics
Key Takeaway
In 422 open tibial fractures across 18 Latin American trauma centers, initial definitive IMN was associated with significantly higher 1-year SF-12 PCS, MCS, and mRUST scores compared to staged fixation, yet staged management was applied even to low-grade (GA Type I/II) injuries.
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Summary
This multicenter prospective study across 18 centers in 8 Latin American countries evaluated HRQoL (SF-12 PCS/MCS) and radiographic union (mRUST) at 1 year following isolated open tibial diaphyseal fractures stratified by fixation strategy. Initial definitive IMN was associated with significantly higher PCS, MCS, and mRUST scores at 1 year compared to staged fixation across all GA types combined. Staged fixation was disproportionately applied to GA IIIA and IIIB/C injuries, but was also commonly used for GA Type I/II fractures, suggesting resource or practice-pattern constraints beyond injury severity alone.
Key Limitation
Non-randomized treatment allocation with significant confounding by injury severity—GA Type IIIA/B/C fractures were disproportionately staged—makes causal inference about fixation strategy and outcomes unreliable without robust risk adjustment.
Original Abstract
BACKGROUND
The study compared health-related quality of life and fracture-healing based on the fixation method following isolated open tibial fractures in Latin America.
METHODS
A prospective study was conducted across 18 trauma centers in 8 countries. Adult patients with isolated open tibial diaphyseal fractures were included. The primary outcome measures were Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Health Survey (SF-12), which was administered at baseline and at follow-up at 6, 12, 26, and 52 weeks. The secondary outcome measure was the modified Radiographic Union Scale for Tibial Fractures (mRUST) score.
RESULTS
Of 422 patients, 389 had a baseline evaluation, with 352 (83.4% of the 422) completing at least 1 SF-12 follow-up and 309 (73.2%) completing at least 1 SF-12 follow-up and having radiographic follow-up within 1 year postoperatively. Initial definitive intramedullary nailing and external fixation or casting followed by staged intramedullary nailing were the most common fixation strategies. Both fixation methods were performed with similar frequency for Gustilo-Anderson (GA) Type-I and II injuries. The majority of GA Type-IIIA and IIIB/C fractures were treated with staged fixation. The presence of minimal or superficial contamination did not influence whether fractures were treated with initial intramedullary nailing or staged intramedullary nailing, whereas the presence of deep contamination was associated with staged management. For all GA types combined, initial definitive intramedullary nailing was associated with significantly higher PCS and MCS scores at 1 year than staged fixation. The mRUST scores at 1 year for all GA types combined were higher with initial definitive intramedullary nailing than with staged intramedullary nailing.
CONCLUSIONS
Staged treatment remains common in Latin America, even for less severe injuries. Initial intramedullary nailing was associated with improved PCS and MCS scores and significantly higher mRUST scores relative to staged intramedullary nailing.
LEVEL OF EVIDENCE
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.