Prediction of tibial nonunion at the 6-week time point

• Published in: Injury 2018-11, Vol.49 (11), p.2075-2082
• Main 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.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Fracture Fixation, Intramedullary - adverse effects; Fracture Fixation, Intramedullary - instrumentation; Fracture Healing - physiology; Fractures, Ununited - diagnostic imaging; Fractures, Ununited - physiopathology; Fractures, Ununited - surgery; Humans; Intramedullary nail; Male; Middle Aged; Nonunion; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Prediction model; Predictive Value of Tests; Retrospective Studies; Risk Factors; Tibia; Tibial fracture; Tibial Fractures - diagnostic imaging; Tibial Fractures - physiopathology; Tibial Fractures - surgery; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2018.07.033

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). 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. 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