OBJECTIVES: Potential complications of tibial shaft fractures treated with open reduction and internal fixation (ORIF) include infection, and non-union. Type III open fractures are the result of high energy trauma which typically result in bone loss and lacerations. This study evaluated 1-year rates of infection and non-union along with health care resource utilization and costs in patients with type III open fractures of the tibial shaft requiring ORIF in the United States (US).

METHODS: This retrospective observational cohort study included data from Truven Commercial Claims and Encounters database. Patients aged ≥18 years with Gustilo type III open fractures of the tibia requiring ORIF during an out- or an inpatient admission occurring between January 1, 2007 through June 30, 2017 were included in the study. Outcomes of interest were Infection, non-union , health care resource utilization in terms of readmissions and emergency room visits and all-cause costs during 1-year follow-up period after ORIF.

RESULTS: A total of 580 patients with open tibial type III fractures that underwent ORIF were identified. Most of the patients were male (78.97%) with a mean(SD) age of 38.79(13.98) years and the mean(SD) Charlson co-morbidity index of 0.25(0.74). The rates of infection and non-union during the 1-year follow-up period were 35.99%. and 36.94% respectively. The rates of readmission and emergency room visits during the follow-up were 48.41% and 34.08% respectively. The mean(SD) total healthcare cost during the 1-year follow-up was $62,060 ($78,802) which was mostly due to medical costs ($ 59,502) and to a lesser extent, prescription ($2,558) costs.

CONCLUSIONS: Patients receiving ORIF for type III open tibial shaft fractures have high complication rates and increased health care resource utilization and costs in the US. Better cost efficient medical techniques are required to successfully treat patients and address the current economic burden.