Fracture union following internal fixation in the HIV population

“…Pro [32] NSAID use at admission Pro [13,27] Con [17,35] NSAID use at discharge Pro [13,27] Con [17,35] Opioid use at admission Pro [12] Opioid use at discharge Pro [12] Human immunodeficiency virus Pro [24] Con [20] Hepatitis C None Diabetes Pro [13,21,27] ASA score Pro [16] Smoking status Pro [13,21,31,36] Con [29,35] Alcohol use Pro [10,13,21] AO classification Pro [30] Con [2,22] ISS score Pro [30] TRISS score Pro [30] ICU days None * Pro articles support a correlation between nonunion and the variable; Con articles show that the variable has no correlation with nonunion; GSW = gunshot wound; NSAID = nonsteroidal anti-inflammatory drug; ASA = American Society of Anesthesiologists; AO = Arbeitsgemeinschaft für Osteosynthesefragen; ISS = Injury Severity Score; TRISS = Trauma and Injury Severity Score; ICU = intensive care unit.…”

Section: Compartment Syndromementioning

confidence: 99%

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

O’Halloran

Coale

Costales

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background 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. Questions/purposes 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. Methods 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 ratio [ 2) at the p \ 0.05 level. Results A multiple variable logistic regression model was developed, including seven factors (p \ 0.05; odds ratio [ 2.0). 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%; and[12, 61%. Conclusions 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 of Evidence Level III, diagnostic study.

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“…They observed a non-union rate of 7.7% in femur fractures (the most frequent injury in their study) which was comparable to that found in series involving seronegative patients, whose non-union rate ranged from 0-10% in the femur. 18 Immune compromise has been mentioned as a risk factor for the development of infection following human bites to the hand. 7,[12][13][14][15]19 Our data suggests that an HIV-positive patient is not necessarily at increased risk for the development of early complications, irrespective of anti-retroviral therapy or the patient's CD4 count.…”

Section: Resultsmentioning

confidence: 99%