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Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study
BACKGROUND: Tibial shaft fractures are the most common long bone fracture and are prone to complications such as nonunion requiring reoperations to promote fracture healing. We aimed to determine the fracture characteristics associated with tibial fracture nonunion, and their predictive value on the...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614478/ https://www.ncbi.nlm.nih.gov/pubmed/23517574 http://dx.doi.org/10.1186/1471-2474-14-103 |
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author | Fong, Katie Truong, Victoria Foote, Clary J Petrisor, Brad Williams, Dale Ristevski, Bill Sprague, Sheila Bhandari, Mohit |
author_facet | Fong, Katie Truong, Victoria Foote, Clary J Petrisor, Brad Williams, Dale Ristevski, Bill Sprague, Sheila Bhandari, Mohit |
author_sort | Fong, Katie |
collection | PubMed |
description | BACKGROUND: Tibial shaft fractures are the most common long bone fracture and are prone to complications such as nonunion requiring reoperations to promote fracture healing. We aimed to determine the fracture characteristics associated with tibial fracture nonunion, and their predictive value on the need for reoperation. We further aimed to evaluate the predictive value of a previously-developed prognostic index of three fracture characteristics on nonunion and reoperation rate. METHODS: We conducted an observational study and developed a risk factor list from previous literature and key informants in the field of orthopaedic surgery, as well as via a sample-to-redundancy strategy. We evaluated 22 potential risk factors for the development of tibial fracture nonunion in 200 tibial fractures. We also evaluated the predictive value of a previously-identified prognostic risk index on secondary intervention and/or reoperation rate. Two individuals independently extracted the data from 200 patient electronic medical records. An independent reviewer assessed the initial x-ray, the post-operative x-ray, and all available sequential x-rays. Regression and chi-square analysis was used to evaluate potential associations. RESULTS: In our cohort of patients, 37 (18.5%) had a nonunion and 27 (13.5%) underwent a reoperation. Patients with a nonunion were 97 times (95% CI 25.8-366.5) more likely to have a reoperation. Multivariable logistic regression revealed that fractures with less than 25% cortical continuity were predictive of nonunion (odds ratio = 4.72; p = 0.02). Such fractures also accounted for all of the reoperations identified in our sample. Furthermore, our data provided preliminary validation of a previous risk index predictive of reoperation that includes the presence of a fracture gap post-fixation, open fracture, and transverse fracture type as variables, with an aggregate of fracture gap and an open fracture yielding patients with the highest risk of developing a nonunion. CONCLUSIONS: We identified a significant association between degree of cortical continuity and the development of a nonunion and risk for reoperation in tibial shaft fractures. In addition, our study supports the predictive value of a previous prognostic index, which inform discussion of prognosis following operative management of tibial fractures. |
format | Online Article Text |
id | pubmed-3614478 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-36144782013-04-03 Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study Fong, Katie Truong, Victoria Foote, Clary J Petrisor, Brad Williams, Dale Ristevski, Bill Sprague, Sheila Bhandari, Mohit BMC Musculoskelet Disord Research Article BACKGROUND: Tibial shaft fractures are the most common long bone fracture and are prone to complications such as nonunion requiring reoperations to promote fracture healing. We aimed to determine the fracture characteristics associated with tibial fracture nonunion, and their predictive value on the need for reoperation. We further aimed to evaluate the predictive value of a previously-developed prognostic index of three fracture characteristics on nonunion and reoperation rate. METHODS: We conducted an observational study and developed a risk factor list from previous literature and key informants in the field of orthopaedic surgery, as well as via a sample-to-redundancy strategy. We evaluated 22 potential risk factors for the development of tibial fracture nonunion in 200 tibial fractures. We also evaluated the predictive value of a previously-identified prognostic risk index on secondary intervention and/or reoperation rate. Two individuals independently extracted the data from 200 patient electronic medical records. An independent reviewer assessed the initial x-ray, the post-operative x-ray, and all available sequential x-rays. Regression and chi-square analysis was used to evaluate potential associations. RESULTS: In our cohort of patients, 37 (18.5%) had a nonunion and 27 (13.5%) underwent a reoperation. Patients with a nonunion were 97 times (95% CI 25.8-366.5) more likely to have a reoperation. Multivariable logistic regression revealed that fractures with less than 25% cortical continuity were predictive of nonunion (odds ratio = 4.72; p = 0.02). Such fractures also accounted for all of the reoperations identified in our sample. Furthermore, our data provided preliminary validation of a previous risk index predictive of reoperation that includes the presence of a fracture gap post-fixation, open fracture, and transverse fracture type as variables, with an aggregate of fracture gap and an open fracture yielding patients with the highest risk of developing a nonunion. CONCLUSIONS: We identified a significant association between degree of cortical continuity and the development of a nonunion and risk for reoperation in tibial shaft fractures. In addition, our study supports the predictive value of a previous prognostic index, which inform discussion of prognosis following operative management of tibial fractures. BioMed Central 2013-03-22 /pmc/articles/PMC3614478/ /pubmed/23517574 http://dx.doi.org/10.1186/1471-2474-14-103 Text en Copyright © 2013 Fong et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Fong, Katie Truong, Victoria Foote, Clary J Petrisor, Brad Williams, Dale Ristevski, Bill Sprague, Sheila Bhandari, Mohit Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study |
title | Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study |
title_full | Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study |
title_fullStr | Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study |
title_full_unstemmed | Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study |
title_short | Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study |
title_sort | predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614478/ https://www.ncbi.nlm.nih.gov/pubmed/23517574 http://dx.doi.org/10.1186/1471-2474-14-103 |
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