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

Autor: Timothy Costales, Renan C. Castillo, Timothy Zerhusen, Robert V O'Toole, Jason W. Nascone, Max Coale, Kevin O'Halloran
Rok vydání: 2016
Předmět:
Male
Time Factors
Sports medicine
Databases
Factual
Bone Nails
law.invention
Intramedullary rod
0302 clinical medicine
law
Risk Factors
Fracture fixation
Odds Ratio
Medicine
Orthopedics and Sports Medicine
Aged
80 and over
Fracture Healing
030222 orthopedics
Symposium: Current Issues in Orthopaedic Trauma: Tribute to Clifford H. Turen
General Medicine
Middle Aged
musculoskeletal system
Fracture Fixation
Intramedullary
surgical procedures
operative
Treatment Outcome
Predictive value of tests
Female
musculoskeletal diseases
Adult
medicine.medical_specialty
Adolescent
Nonunion
Risk Assessment
Decision Support Techniques
03 medical and health sciences
Young Adult
Predictive Value of Tests
Humans
Tibia
Aged
Retrospective Studies
Chi-Square Distribution
business.industry
030208 emergency & critical care medicine
Retrospective cohort study
equipment and supplies
medicine.disease
Surgery
Tibial Fractures
Logistic Models
Fractures
Ununited
Orthopedic surgery
Baltimore
Multivariate Analysis
business
Zdroj: Clinical orthopaedics and related research. 474(6)
ISSN: 1528-1132
Popis: Accurate prediction of tibial nonunions has eluded researchers. Reliably predicting tibial nonunions at the time of fixation could change management strategies and stimulate further research.We asked (1) whether data from medical records, fracture characteristics, and radiographs obtained at the time of fixation would identify features predictive of tibial fracture nonunion; and (2) whether this information could be used to create a model to assess the chance of nonunion at the time of intramedullary (IM) nail fixation of the tibia.We retrospectively reviewed all tibial shaft fractures treated at our center from 2007 to 2014. We conducted a literature review and collected data on 35 factors theorized to contribute to delayed bone healing. Patients were followed to fracture healing or surgery for nonunion. Patients with planned prophylactic nonunion surgery were excluded because their nonunions were anticipated and our focus was on unanticipated nonunions. Our cohort consisted of 382 patients treated with IM nails for tibial shaft fractures (nonunion, 56; healed, 326). Bivariate and multivariate regression techniques and stepwise modeling approaches examined the relationship between variables available at definitive fixation. Factors were included in our model if they were identified as having a modest to large effect size (odds ratio2) at the p0.05 level.A multiple variable logistic regression model was developed, including seven factors (p0.05; odds ratio2.0). With these factors, we created the Nonunion Risk Determination (NURD) score. The NURD score assigns 5 points for flaps, 4 points for compartment syndrome, 3 points for chronic condition(s), 2 points for open fractures, 1 point for male gender, and 1 point per grade of American Society of Anesthesiologists Physical Status and percent cortical contact. One point each is subtracted for spiral fractures and for low-energy injuries, which were found to be predictive of union. A NURD score of 0 to 5 had a 2% chance of nonunion; 6 to 8, 22%; 9 to 11, 42%; and12, 61%.The proposed nonunion prediction model (NURDS) seems to have potential to allow clinicians to better determine which patients have a higher risk of nonunion. Future work should be directed at prospectively validating and enhancing this model.Level III, diagnostic study.
Databáze: OpenAIRE
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