Complicaciones postoperatorias en pacientes con fractura de tibia tratados con clavo endomedular vs. placa bloqueada en el Hospital Guayaquil Abel Gilbert Pontón del periodo 2020 – 2025.

Abstract

Introduction: Tibial fractures are among the most frequent long bone injuries in traumatology practice in Ecuador, with intramedullary nailing and locked plating being the two predominant surgical alternatives. The comparison of their postoperative complication profiles in the Ecuadorian hospital context remains a gap in the local evidence base. Objective: To compare the frequency and type of postoperative complications in adult patients with tibial fractures treated with intramedullary nailing versus locked plating at Hospital Guayaquil Abel Gilbert Pontón during the 2020-2025 period. Methods: Observational, retrospective, longitudinal, analytical comparative study. 180 adult patients aged 18 to 65 years surgically treated with locked intramedullary nailing or locked plating were included. Data were obtained through systematic review of clinical and institutional records. Descriptive analysis, bivariate analysis with chi-square or Fisher exact test, and binary multivariate logistic regression were applied. The significance level was set at p < 0.05. Data processing was performed in Jamovi 2.6.44. Results: 180 patients were analyzed with a mean age of 35.4 ± 12.8 years and male predominance (83.3%). Motorcycle accidents were the most frequent mechanism (51.1%). Intramedullary nailing was used in 112 cases (62.2%) and locked plating in 68 (37.8%). The overall postoperative complication rate was 32.2% (n=58). The intramedullary nailing group had lower superficial infection (4.5% vs. 10.3%) and deep infection (2.7% vs. 5.9%) but higher incidence of anterior knee pain (17.9% vs. 1.5%) and malunion (12.5% vs. 5.9%). In multivariate analysis, open Gustilo-Anderson fracture (OR 3.52; 95% CI 1.78-6.96), diabetes mellitus (OR 2.87; 95% CI 1.32-6.24), active smoking (OR 2.34; 95% CI 1.08-5.08) and age over 50 years (OR 2.14; 95% CI 1.05-4.36) were independently associated with the development of complications. Surgical technique alone was not an independent predictor (p=0.312). Conclusions: Both techniques are valid alternatives with complication profiles that differ more in nature than in overall frequency. The choice should be individualized based on fracture characteristics, soft tissue quality and patient comorbidities.