• Injury · Nov 2018

    Prediction of tibial nonunion at the 6-week time point.

    • Keir A Ross, Kevin O'Halloran, Renan C Castillo, Max Coale, Justin Fowler, Jason W Nascone, Marcus F Sciadini, Christopher T LeBrun, Theodore T Manson, Anthony R Carlini, Josef E Jolissaint, and Robert V O'Toole.
    • R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, Baltimore, Maryland, United States.
    • Injury. 2018 Nov 1; 49 (11): 2075-2082.

    IntroductionIntramedullary (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).MethodsA 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.ResultsInfection 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.ConclusionThree 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.Copyright © 2018. Published by Elsevier Ltd.

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