• John C Prather, Tyler Montgomery, Brent Cone, Jonathan H Quade, Kenneth Fellows, Thomas L Devine, and Clay A Spitler.
• Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and.
• J Orthop Trauma. 2021 Mar 1; 35 (3): 143-148.

ObjectivesTo identify a group of ballistic tibia fractures, report the outcomes of these fractures, and compare them with both closed and open tibia fractures sustained by blunt mechanisms. We hypothesized that ballistic tibia fractures and blunt open fractures would have similar outcomes.DesignRetrospective cohort study.SettingA single Level-1 trauma center.Patients/ParticipantsAdult patients presenting with ballistic (44), blunt closed (179), or blunt open (179) tibia fractures.InterventionIntramedullary stabilization of tibia fracture.Main OutcomesUnplanned reoperation, soft tissue reconstruction, nonunion, compartment syndrome, and fracture-related infection.ResultsCompared with the blunt closed group, the ballistic fracture group required more operations (P < 0.01), had a higher occurrence of soft tissue reconstruction (P < 0.01), and higher incidence of compartment syndrome (P = 0.02). Ballistic and blunt closed groups did not significantly differ in rates of unplanned reoperation (P = 0.67), nonunion (11.4% vs. 4.5%, P = 0.08), or deep infection (9.1% vs. 5.6%, P = 0.49). In comparison to the blunt open group, the ballistic group required a similar number of operations (P = 0.12), had similar rates of unplanned reoperation (P = 0.10), soft tissue reconstruction (P = 0.56), nonunion (11.4% vs. 17.9%, P = 0.49), and fracture-related infection (9.1% vs. 10.1%, P = 1.0) but a higher incidence of compartment syndrome (15.9% vs. 5.0%, P = 0.02).ConclusionsBallistic tibia fractures require more surgeries and have higher rates of soft tissue reconstruction than blunt closed fractures and seem to have outcomes similar to lower severity open fractures. We found a significantly higher rate of compartment syndrome in ballistic tibia fractures than both open and closed blunt fractures. When treating ballistic tibia fractures, surgeons should maintain a high level of suspicion for the development of compartment syndrome and counsel patients that ballistic tibia fractures seem to behave like an intermediate category between closed and open fractures sustained through blunt mechanisms.Level Of EvidencePrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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