Prediction of tibial nonunion at the 6-week time point. Issue 11 (November 2018)

• Record Type: Journal Article
• Authors: Ross, Keir A.; O'Halloran, Kevin; Castillo, Renan C.; Coale, Max; Fowler, Justin; Nascone, Jason W.; Sciadini, Marcus F.; LeBrun, Christopher T.; Manson, Theodore T.; Carlini, Anthony R.; Jolissaint, Josef E.; O'Toole, Robert V.
• Is Part Of: Injury. Volume 49:Issue 11(2018)
• Page Start: 2075
• Page End: 2082
• Publication Date: 2018-11
• Subjects: Tibia -- Tibial fracture -- Nonunion -- Intramedullary nail -- Prediction model; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2018.07.033
• Languages: English
• ISSNs: 0020-1383

Abstract

Abstract: Introduction: Intramedullary (IM) nail fixation is a common operative treatment, yet concerns regarding the frequency of complications, such as nonunion, remain. Treatment of tibial shaft fractures remains a challenge, and little evidence of prognostic factors that increase risk of nonunion is available. The aim of this study was to develop a predictive model of tibial shaft fracture nonunion 6 weeks after reamed intramedullary (IM) nail fixation based on commonly collected clinical variables and the radiographic union score for tibial fractures (RUST). Methods: A retrospective case-control study was conducted. All tibial shaft fractures treated at our level I trauma center from 2007 to 2014 were retrospectively reviewed. Only patients with follow-up until fracture healing or secondary operation for nonunion were included. Fracture gaps ≥3 mm were excluded. A total of 323 patients were included for study. Results: Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). The NURD score was increasingly predictive of nonunion with decreasing RUST. All patients in the high RUST group (RUST ≥ 10), achieved union regardless of NURD score. In the medium RUST group (RUST 6–9), 25% of patients with a NURD score ≥7 experienced nonunion. In the low RUST group (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion. Conclusion: Three variables predicted nonunion. Based on these variables, we created a clinical prediction tool of nonunion that could aid in clinical decision making and discussing prognosis with patients.