Study identifies clinical, radiographic predictors of nonunion in tibial shaft fractures
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High-energy etiology, Gustilo-Anderson class IIIA injury, lack of cortical continuity and early postoperative complications, such as infection, are significant predictors of nonunion in diaphyseal tibia fractures, according to results.
Researchers retrospectively reviewed the results of 98 patients with 104 extra-articular open tibial shaft fractures that underwent irrigation and debridement followed by definitive intramedullary nailing or plate fixation from 2007 to 2018. Researchers used anteroposterior and lateral radiographs to analyze patient, injury and perioperative prognostic factors of nonunion, according to the study.
Overall, nonunion was reported in 27.9% of fractures (n = 29) and deep infection occurred in 11.5% of cases (n = 12). After univariable and multivariable analyses, researchers found high-energy mechanism of injury, Gustilo-Anderson class IIIA injury, postoperative cortical continuity of 0% to 25%, early postoperative complication and deep infection were significant predictors of nonunion.
“Although further prospective studies are needed to draw a solid conclusion regarding the ability of cortical continuity to predict nonunion, fracture gap should be taken into consideration given that fractures with limited or no cortical contact following fixation may be more likely to go on to nonunion and may warrant a staged approach,” the researchers wrote in the study. “These patients should be counseled appropriately and targeted as high-risk groups for further intervention,” they wrote.
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