Prediction of tibial nonunion at the 6-week time point
| Autor: | Josef E. Jolissaint, Justin Fowler, Theodore T. Manson, Renan C. Castillo, Anthony R. Carlini, Jason W. Nascone, Marcus F. Sciadini, Keir A. Ross, Christopher T. LeBrun, Robert V O'Toole, Max Coale, Kevin O’Halloran |
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| Rok vydání: | 2018 |
| Předmět: |
musculoskeletal diseases
Adult Male medicine.medical_specialty Time Factors Radiography Nonunion Bone healing law.invention Intramedullary rod 03 medical and health sciences Fixation (surgical) Young Adult 0302 clinical medicine Postoperative Complications law Predictive Value of Tests Risk Factors medicine Humans 030212 general & internal medicine Tibia General Environmental Science Aged Retrospective Studies Aged 80 and over Fracture Healing 030222 orthopedics business.industry Trauma center Odds ratio Middle Aged equipment and supplies musculoskeletal system medicine.disease Surgery Fracture Fixation Intramedullary Tibial Fractures surgical procedures operative Treatment Outcome Case-Control Studies Fractures Ununited General Earth and Planetary Sciences Female business |
| Zdroj: | Injury. 49(11) |
| ISSN: | 1879-0267 |
| Popis: | Intramedullary (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).A 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.Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratioor1.0; p0.01). 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 (RUST6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion.Three 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. |
| Databáze: | OpenAIRE |
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