Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures

Abstract

As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was > or = 3 mm.

External fixation of tibial pilon fractures and fracture healing

“…Our findings on displacement are consistent with those of Drosos et al, who found that a post-reduction fracture gap of ≥ 3 mm with a statically locked nail was associated with a significantly longer time to union than a gap of < 3 mm (Drosos et al 2006). The degree of comminution was also significantly associated with healing, and there was a tendency towards slower healing in distal fractures compared to midshaft and proximal fractures.…”

“…Translational displacement has been recognized as a risk factor for delayed union in the treatment of tibial shaft fractures (Helland et al 1996, Audigé 2005, Drosos 2006), but it has received no attention in tibial pilon fractures. Our findings on displacement are consistent with those of Drosos et al, who found that a post-reduction fracture gap of ≥ 3 mm with a statically locked nail was associated with a significantly longer time to union than a gap of < 3 mm (Drosos et al 2006).…”

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

“…We understand that postoperative fracture gap does play an important role in nonunion, and we think that most clinicians do not require 0.006 AO = Arbeitsgemeinschaft für Osteosynthesefragen; GSW = gunshot wound; ASA = American Society of Anesthesiologists; EtOH = ethyl alcohol; WB = weightbearing; WBAT = weightbearing as tolerated. assistance in predicting nonunions among fractures that have sizeable gaps postoperatively [18]. The treatment dilemma that currently exists concerns the fracture with at least some cortical contact postoperatively [19,33].…”

Nonunion of the tibia following intramedullary nailing treated by Ilizarov external fixator: A case report

“…Too much or too little motion at the fracture site, excessive space between fracture fragments, inadequate fixation, infection, soft tissue interposition, inadequate blood supply, and many other factors can lead to nonunion (Shuler 1996;Rosen 1998;Audige et al, 2005;Drosos et al, 2006). Our patient had not any well-known causes of pseudoarthrosis.…”