{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T11:04:16Z","timestamp":1794654256767,"version":"4.9.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6]]},"abstract":"\n Objective:<\/jats:title>\n To assess the outcomes of patients who sustained blunt trauma tibia fractures compared with tibia fractures from civilian gunshot injuries when treated with intramedullary fixation.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective chart review.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Level I trauma center.<\/jats:p>\n <\/jats:sec>\n \n Patients\/Participants:<\/jats:title>\n Two hundred and seven patients underwent intramedullary nailing for 211 tibia fractures.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A retrospective review of tibia fracture(s) treated with intramedullary fixation with comparison of closed, open, and gunshot wound (GSW) fracture outcomes.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measurements:<\/jats:title>\n Outcomes included infection and nonunion.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The infection rate in closed and GSW tibia fractures was significantly lower compared with the infection rate of open fractures (1% vs. 9% vs. 20%;\n P<\/jats:italic>\n = 0.00005). Significantly lower rates of nonunion in closed fractures compared with open fractures and GSW fractures were appreciated (8% vs. 20% vs. 30%;\n P<\/jats:italic>\n = 0.003). There was no difference in infection or nonunion between GSW fractures with small wounds, no exposed bone, and minimal comminution and closed injuries (\n P<\/jats:italic>\n = 0.24,\n P<\/jats:italic>\n = 0.60). Conversely, there was a significantly higher nonunion rate in GSW fractures with large wounds, exposed tibia, and comminution compared with blunt injuries (\n P<\/jats:italic>\n = 0.0014).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n This study suggests that tibia fractures from civilian GSWs are heterogeneous injuries, and outcomes are dependent on the extent of soft-tissue injury, bone exposure, and bone loss. There are comparable infection rates in all fractures due to civilian GSWs and closed fractures, which are lower than high-grade open fractures. Tibia GSW fractures with exposed bone and comminution have higher complication rates and should be treated accordingly.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000001709","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T02:17:16Z","timestamp":1574648236000},"page":"e208-e213","source":"Crossref","is-referenced-by-count":29,"title":["Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review"],"prefix":"10.1097","volume":"34","author":[{"given":"Kathryn B.","family":"Metcalf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Wetzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John 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