Risk Factors for Failure of Bone Grafting of Tibia Nonunions and Segmental Bone Defects: A New Preoperative Risk Assessment Score

Maceroli, Michael; Gage, Mark J.; Wise, Brent; Connelly, Daniel; Ordonio, Katherine; Castillo, Renan C.; Jarman, Molly P.; Nascone, Jason W.; O’Toole, Robert V.; Sciadini, Marcus F.

doi:10.1097/bot.0000000000000982

Cited by 8 publications

(9 citation statements)

References 48 publications

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“…Tibia is a kind of subcutaneous bone vulnerable to trauma, and its fracture is mostly open, which is more common in long bone fracture. Clinically, the massive bone defect of tibia is mostly caused by high-energy injury, and patients are often accompanied by serious tissue injury of muscles, nerves, and blood vessels [16,17]. Bone transport technique is a common method for the treatment of traumatic massive bone defect of tibia, and it can achieve a good therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

Effect of Annular External Fixator-Assisted Bone Transport on Clinical Healing, Pain Stress and Joint Function of Traumatic Massive Bone Defect of Tibia

Song

Shao

2022

Computational and Mathematical Methods in Medicine

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Objective. To investigate the effect of annular external fixator-assisted bone transport in the treatment of traumatic massive bone defect of tibia on clinical healing, pain stress, and joint function. Methods. From January 2018 to November 2021, 146 patients with traumatic massive bone defect of tibia were selected as the research objects, and they were divided into observation group (annular external fixator-assisted bone transport, 71 cases) and control group (unilateral external fixator bone lengthening, 75 cases) according to different surgical methods. The therapeutic efficacy, fracture healing-related indexes, and postoperative range of motion of the knee joint were compared between the two groups. Callus healing was evaluated by Fernandez-Esteve callus score, and joint function was evaluated by Paley score, American Knee society score (AKSS), and Baird-Jackson ankle score. The changes of pain mediator (serum substance P (SP), neuropeptide Y (NPY), prostaglandin E2 (PGE2), and tumor necrosis factor-α (TNF-α)) and stress indexes (adrenocorticotropic hormone (ACTH), cortisol (COR), and nor Epinephrine (NE)) were observed before and after treatment in two groups. The incidence of postoperative complications was analyzed. Results. There were no significant differences in total effective rate and bone lengthening between the two groups ( P > 0.05 ). The bone healing time and callus formation time in the observation group were shorter than those in the control group, and the Fernandez-Esteve callus score was higher than that in the control group ( P < 0.05 ). The levels of SP, NPY, PGE2, TNF-α, ACTH, COR, and NE in the observation group were lower than those in the control group ( P < 0.05 ). AKSS and Baird-Jackson scores in the observation group after operation were higher than those in the control group ( P < 0.05 ). There was no significant difference in the incidence of postoperative complications between the two groups ( P > 0.05 ). Conclusion. Annular external fixator-assisted bone transport can promote postoperative fracture healing, reduce pain stress level, and improve joint function of patients with traumatic massive bone defect of tibia.

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Section: Discussionmentioning

confidence: 99%

Effect of Annular External Fixator-Assisted Bone Transport on Clinical Healing, Pain Stress and Joint Function of Traumatic Massive Bone Defect of Tibia

Song

Shao

2022

Computational and Mathematical Methods in Medicine

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“…Furthermore, many nonunion studies report healing rates independent of the number of operations required to achieve union. 18,[22][23][24][25][26] In the present study, we defined a recalcitrant tibial nonunion as one that failed to unite after the index nonunion operation at our institution. The goal of this study was (1) to compare and stratify the healing rates after our index nonunion surgery using contemporary methods of internal fixation (2) to report the prevalence of recalcitrant tibial nonunions, and (3) to identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, many nonunion studies report healing rates independent of the number of operations required to achieve union. 18,22–26…”

Section: Introductionmentioning

confidence: 99%

Healing the Index Tibial Nonunion: Risk Factors for Development of a Recalcitrant Nonunion in 222 Patients

Wiss¹,

Garlich

Sherman

2021

Journal of Orthopaedic Trauma

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“…Previous research has identified Medicaid enrollment as a predictor of recurrent trauma and as a risk factor for nonunion in tibia fractures. 32,33 We believe that Medicaid enrollment likely serves as a proxy for an individual's risk of suffering major trauma rather than socioeconomic status. Although there were significant differences in median household income between the control and nonunion cohorts, this is likely confounded by the large difference in the unknown income category because the regression results failed to demonstrate that a higher income quartile was protective against nonunion.…”

Section: Discussionmentioning

confidence: 99%

Familial Analysis of Nonunion in a Genealogic Population Database Demonstrates No Evidence of Heritable Risk

Kantor

O’Neill

Steffenson

et al. 2023

Journal of Orthopaedic Trauma

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OBJECTIVE: To determine if there is evidence of heritable risk for nonunion using a large, state-wide population database. DESIGN: Database SETTING: Level 1 Trauma Center POPULATION: All Utah residents from 1996 – 2021 that sustained a long bone fracture and their family members. OUTCOMES: The primary outcome was nonunion and the prevalence of nonunion among the patients’ first-, second-, and third-degree relatives. The secondary objective was to identify demographic, injury, and socioeconomic risk factors associated with nonunion. RESULTS: In total, 150,263 fractures and 6,577 (4.4%) nonunions were identified. This was highly refined to a 1:3 matched cohort of 4,667 nonunions of 13,981 fractures for familial clustering analysis. Cox proportional hazards did not demonstrate excessive risk of nonunion amongst first- (p = 0.863), second- (p = 0.509), and third-degree relatives (p = 0.252). Further analysis of the entire cohort demonstrated male sex (RR = 1.15; p < 0.001), Medicaid enrollment (RR = 2.64; p < 0.001), open fracture (RR = 2.53; p < 0.001), age group 41-60 (RR = 1.43; p < 0.001), a history of obesity (RR = 1.20; p < 0.001) were independent risk factors for nonunion. CONCLUSIONS: Our results demonstrate no evidence of heritable risk for nonunion. Independent risk factors for nonunion were male sex, Medicaid enrollment, open fracture, middle age, and a history of obesity. While it is important to identify modifiable and non-modifiable risk factors, these results continue to support that the risk of nonunion is multifactorial, relating to injury characteristics, operative techniques, and patient specific risk factors. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

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Risk Factors for Failure of Bone Grafting of Tibia Nonunions and Segmental Bone Defects: A New Preoperative Risk Assessment Score

Abstract: This study presents a clinical score that predicts the likelihood of success after surgery for tibia fracture nonunions or traumatic bone defects and may help clinicians better determine which patients are likely to fail these procedures and require further surgery.

Cited by 8 publications

References 48 publications

Effect of Annular External Fixator-Assisted Bone Transport on Clinical Healing, Pain Stress and Joint Function of Traumatic Massive Bone Defect of Tibia

Effect of Annular External Fixator-Assisted Bone Transport on Clinical Healing, Pain Stress and Joint Function of Traumatic Massive Bone Defect of Tibia

Healing the Index Tibial Nonunion: Risk Factors for Development of a Recalcitrant Nonunion in 222 Patients

Familial Analysis of Nonunion in a Genealogic Population Database Demonstrates No Evidence of Heritable Risk

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