Predictors of reoperation following operative management of fractures of the tibial shaft

Abstract

Three risk factors were found to be associated with reoperation within one year following surgery for tibial shaft fractures. Of 192 patients who underwent surgical treatment for tibial shaft fractures, 43 (22.4%) required reoperation at a mean of 18 weeks (range 6-52 weeks). The presence of an open fracture wound, lack of cortical continuity between the fracture ends following fi xation, and the presence of a transverse fracture all predicted reoperation. No interaction between the treatment method (plate or nail) and any of the predictive variables was seen. Patients with none of the three risk factors had a risk of reoperation of 3.8%. Patients with one risk factor had a reoperation rate of 17.7%. Patients with two risk factors had a reoperation rate of 47%, and of the 16 patients with all three risk factors 14 (94%) required reoperation.

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

“…Early interventions may abbreviate the time of disability in high-risk patients and the prediction can be reassuring to those at low risk of nonunion. Although attempts have been made to create an early tibial shaft nonunion prediction model, the models included large postoperative fracture gaps, were clinically cumbersome, or both [2,5,19]. The inclusion of fractures with 0% cortical continuity (a fracture group known to have high nonunion rates) tends to lead to statistically overemphasizing the role of fracture gap in nonunions and underrepresenting other factors that may play a role.…”

“…Despite evidence that cigarette smoking plays a role in nonunion and delayed union [13,21,31,36], precedents for smoking not being associated with nonunion are also reported [5,19]. Some evidence supports IIIC fractures being correlated with nonunions [37].…”

“…No agreed-on and validated radiographic or clinical definition of nonunion has been reached to date. To address this issue, in contrast to previous authors, we excluded bone defects from the sample [2,5,19]. The bone defects can create statistical confusion because some of these cases are ''critical'' defects that have no chance of healing (eg, an 8-cm gap in a tibia).…”

“…Flap (IIIB) Pro [11] Vascular injury Pro [7] Open injury Pro [2,5] Weightbearing status postoperatively Pro [15,26] Con [35] Fibular fracture fixation Pro [15,38] Con [39,42] …”

“…Previous authors, including Audigé et al, Bhandari et al, and Fong et al [2,5,19], have explored factors influencing nonunion in tibial shaft fractures at the time of definitive fixation. However, because these authors included many fractures with postoperative fracture gaps (known high nonunion risk), the authors were unable to elucidate other factors that may be associated with nonunion risk in fractures typically expected to achieve union without further intervention.…”