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Factors that predict nonunion of tibial shaft fractures


An observational study of 200 patients with tibial shaft fractures was performed to identify factors that could be used to predict delayed fracture healing, nonunion and its attendant complications. Data from the patients’ records were independently re-assessed by two researchers, who examined the initial and post-surgery X-rays, together with any available sequential X-rays.

Nonunion was experienced by 37 patients in the cohort (18.5%) and 27 required reoperation to promote healing of their fracture (13.5%). Overall, patients with a nonunion of their fracture were 97 times more likely to need a reoperation.

The most highly predictive factor for nonunion, which occurred in all patients requiring reoperation, was less than 25% cortical continuity (odds ratio 4.72; P=0.02). The findings also confirmed that the presence of one, two or three prognostic risk factors previously identified (presence of a fracture gap after surgical fixation, an open fracture, or a transverse fracture) increased incrementally the need for reoperation.

Editor’s comment: Early predictors of nonunion are important guides for the discussions that a surgeon has with individual patients on their prognosis after surgical repair of tibial shaft fractures, but they are also required for the clinical protocols used when designing clinical trials for at-risk populations.

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