Prediction of tibial nonunion at the 6-week time point

Keir A. Ross, Kevin O'Halloran, Renan Carlos Castillo, Max Coale, Justin Fowler, Jason W. Nascone, Marcus F. Sciadini, Christopher T. LeBrun, Theodore T. Manson, Anthony R Carlini, Josef E. Jolissaint, Robert V. O'Toole

Research output: Contribution to journalArticle

Abstract

Introduction: 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). Methods: 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. Results: Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). 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 (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion. Conclusion: 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.

Original languageEnglish (US)
JournalInjury
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

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Tibial Fractures
Nails
Fracture Healing
Trauma Centers
Infection
Case-Control Studies
Odds Ratio

Keywords

  • Intramedullary nail
  • Nonunion
  • Prediction model
  • Tibia
  • Tibial fracture

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Ross, K. A., O'Halloran, K., Castillo, R. C., Coale, M., Fowler, J., Nascone, J. W., ... O'Toole, R. V. (Accepted/In press). Prediction of tibial nonunion at the 6-week time point. Injury. https://doi.org/10.1016/j.injury.2018.07.033

Prediction of tibial nonunion at the 6-week time point. / Ross, Keir A.; O'Halloran, Kevin; Castillo, Renan Carlos; Coale, Max; Fowler, Justin; Nascone, Jason W.; Sciadini, Marcus F.; LeBrun, Christopher T.; Manson, Theodore T.; Carlini, Anthony R; Jolissaint, Josef E.; O'Toole, Robert V.

In: Injury, 01.01.2018.

Research output: Contribution to journalArticle

Ross, KA, O'Halloran, K, Castillo, RC, Coale, M, Fowler, J, Nascone, JW, Sciadini, MF, LeBrun, CT, Manson, TT, Carlini, AR, Jolissaint, JE & O'Toole, RV 2018, 'Prediction of tibial nonunion at the 6-week time point', Injury. https://doi.org/10.1016/j.injury.2018.07.033
Ross, Keir A. ; O'Halloran, Kevin ; Castillo, Renan Carlos ; Coale, Max ; Fowler, Justin ; Nascone, Jason W. ; Sciadini, Marcus F. ; LeBrun, Christopher T. ; Manson, Theodore T. ; Carlini, Anthony R ; Jolissaint, Josef E. ; O'Toole, Robert V. / Prediction of tibial nonunion at the 6-week time point. In: Injury. 2018.
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abstract = "Introduction: 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). Methods: 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. Results: Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). 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 (RUST <6 or infection within 6 weeks), 69{\%} of patients with a NURD score ≥7 experienced nonunion. Conclusion: 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.",
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AU - O'Halloran, Kevin

AU - Castillo, Renan Carlos

AU - Coale, Max

AU - Fowler, Justin

AU - Nascone, Jason W.

AU - Sciadini, Marcus F.

AU - LeBrun, Christopher T.

AU - Manson, Theodore T.

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N2 - Introduction: 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). Methods: 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. Results: Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). 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 (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion. Conclusion: 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.

AB - Introduction: 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). Methods: 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. Results: Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). 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 (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion. Conclusion: 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.

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