Skip to main content

Advertisement

SpringerLink
Log in

Are pre- and postoperative true translational and angular displacement predictive of nonunion after intramedullary nail fixation of tibial shaft fractures?

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To determine if there is an association between pre-/postoperative translational and angular displacement with nonunion after intramedullary nail (IMN) fixation of tibial shaft fractures.

Methods

Retrospective review of 120 patients with tibial shaft fractures undergoing IMN at an urban level-one trauma center was performed. Demographics, injury characteristics, and pre-/postoperative translational and angular fracture displacement in the coronal and sagittal planes were recorded. True fracture translational and angular displacement (TTD and TAD) were calculated by combining sagittal and coronal displacement utilizing the Pythagorean theorem.

Results

10.8% of patients (n = 13) developed nonunion with remaining patients serving as the control. Groups were similar across age, sex, and BMI. Univariate analysis revealed no difference in pre-/postoperative TAD between nonunion and union groups and an increased preoperative TTD (median difference (MD): 6.2 mm, CI: 1.4–10.8 mm) and postoperative TTD (MD: 1.8 mm, CI: 0–3.7 mm) in the nonunion group. On multivariate analysis, however, only tobacco use and type 2 or 3 open fractures were associated with nonunion (OR: 5.1, CI: 1.2–22.8 and OR: 4.9, CI: 1.2–19.2, respectively).

Conclusion

True translational and angular displacement of tibial shaft fractures before and after IMN fixation were not independently associated with nonunion. Tobacco use and type 2 or 3 open fracture are independent factors for nonunion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ekegren C, Edwards E, de Steiger R, Gabbe B (2018) Incidence, costs and predictors of non-union, delayed union and mal-union following long bone fracture. Int J Environ Res Public Health 15:2845–2845. https://doi.org/10.3390/IJERPH15122845

    Article  Google Scholar 

  2. Mills L, Aitken S, Simpson A (2017) The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults. Acta Orthop 88:434–439. https://doi.org/10.1080/17453674.2017.1321351

    Article  Google Scholar 

  3. Antonova E, Le T, Burge R, Mershon J (2013) Tibia shaft fractures: costly burden of nonunions. BMC Musculoskelet Disord. https://doi.org/10.1186/1471-2474-14-42

    Article  Google Scholar 

  4. Bonafede M, Espindle D, Bower A (2013) The direct and indirect costs of long bone fractures in a working age US population. J Med Econ 16:169–178. https://doi.org/10.3111/13696998.2012.737391

    Article  Google Scholar 

  5. O’Halloran K, Coale M, Costales T et al (2016) Will my tibial fracture heal? predicting nonunion at the time of definitive fixation based on commonly available variables. Clin Orthop Relat Res 474:1385–1395. https://doi.org/10.1007/S11999-016-4821-4

    Article  Google Scholar 

  6. Vallier HA (2016) Current evidence: plate versus Intramedullary nail for fixation of distal tibia fractures in 2016. J Orthop Trauma 30:S2–S6. https://doi.org/10.1097/BOT.0000000000000692

    Article  Google Scholar 

  7. Vallier HA, Cureton BA, Patterson BM (2011) Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 25:736–741. https://doi.org/10.1097/BOT.0b013e318213f709

    Article  Google Scholar 

  8. Santolini E, West R, Giannoudis P (2015) Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence. Injury 46(Suppl 8):S8–S19. https://doi.org/10.1016/S0020-1383(15)30049-8

    Article  Google Scholar 

  9. Paley D, Bhave A, Gage J et al (2002) Principles of Deformity Correction, 1st edn. Springer-Verlag, Berlin, Heidelberg

    Book  Google Scholar 

  10. Strage K, Parry J, Mauffrey C (2021) Standardizing statistics and data reporting in orthopaedic research. Eur J Orthop Surg Traumatol 31:1–6. https://doi.org/10.1007/S00590-020-02843-8

    Article  Google Scholar 

  11. Rupp M, Biehl C, Budak M et al (2018) Diaphyseal long bone nonunions — types, aetiology, economics, and treatment recommendations. Int Orthop 42:247–258

    Article  Google Scholar 

  12. Zura R, Xiong Z, Einhorn T et al (2016) Epidemiology of fracture nonunion in 18 human bones. JAMA Surg 151:e162775–e162775. https://doi.org/10.1001/JAMASURG.2016.2775

    Article  Google Scholar 

  13. Brinker M, O’Connor D (2009) Nonunions: evaluation and treatment. In: Saunders WB (ed) Skeletal trauma: basic science, management, and reconstruction, 4th. PA, USA, Philadelphia, pp 637–718

    Google Scholar 

  14. Bhandari M, Tornetta P, Sprague S et al (2003) Predictors of reoperation following operative management of fractures of the tibial shaft. J Orthop Trauma 17:353–361. https://doi.org/10.1097/00005131-200305000-00006

    Article  Google Scholar 

  15. Moghaddam A, Zimmermann G, Hammer K et al (2011) Cigarette smoking influences the clinical and occupational outcome of patients with tibial shaft fractures. Injury 42:1435–1442. https://doi.org/10.1016/J.INJURY.2011.05.011

    Article  Google Scholar 

  16. Scolaro J, Schenker M, Yannascoli S et al (2014) Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am 96:674–681. https://doi.org/10.2106/JBJS.M.00081

    Article  Google Scholar 

  17. Copuroglu C, Calori G, Giannoudis P (2013) Fracture non-union: who is at risk? Injury 44:1379–1382. https://doi.org/10.1016/J.INJURY.2013.08.003

    Article  Google Scholar 

  18. Karladani A, Granhed H, Kärrholm J, Styf J (2001) The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures. Arch Orthop Trauma Surg 121:325–328. https://doi.org/10.1007/s004020000252

    Article  CAS  Google Scholar 

  19. de Giacomo AF, Tornetta P (2016) Alignment after intramedullary nailing of distal tibia fractures without fibula fixation. In: J Orthop Trauma. Lippincott Williams and Wilkins, pp 561–567

  20. Claes L, Augat P, Suger G, Wilke HJ (1997) Influence of size and stability of the osteotomy gap on the success of fracture healing. J Orthop Res 15:577–584. https://doi.org/10.1002/jor.1100150414

    Article  CAS  Google Scholar 

  21. Claes L, Grass R, Schmickal T et al (2002) Monitoring and healing analysis of 100 tibial shaft fractures. Langenbecks Arch Surg 387:146–152. https://doi.org/10.1007/S00423-002-0306-X

    Article  CAS  Google Scholar 

  22. Fong K, Truong V, Foote C et al (2013) Predictors of nonunion and reoperation in patients with fractures of the tibia: an observational study. BMC Musculoskelet Disord. https://doi.org/10.1186/1471-2474-14-103

    Article  Google Scholar 

  23. Sanders R, Jersinovich I, Anglen J et al (1994) The treatment of open tibial shaft fractures using an interlocked intramedullary nail without reaming. J Orthop Trauma 8:504–510

    Article  CAS  Google Scholar 

  24. Court-Brown C (2004) Reamed intramedullary tibial nailing: an overview and analysis of 1106 cases. J Orthop Trauma 18:96–101. https://doi.org/10.1097/00005131-200402000-00007

    Article  CAS  Google Scholar 

  25. Audigé L, Griffin D, Bhandari M et al (2005) Path analysis of factors for delayed healing and nonunion in 416 operatively treated tibial shaft fractures. Clin Orthop Relat Res 438:221–232. https://doi.org/10.1097/01.BLO.0000163836.66906.74

    Article  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, USA

    Nicholas J. Tucker, Cyril Mauffrey & Joshua A. Parry

  2. University of Colorado School of Medicine, Aurora, CO, USA

    Cyril Mauffrey & Joshua A. Parry

Authors
  1. Nicholas J. Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cyril Mauffrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joshua A. Parry
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made substantial contributions to this work and give explicit consent for submission. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Joshua A. Parry.

Ethics declarations

Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

Institutional review board approval was obtained prior to initiating this study.

Informed consent

Due to the retrospective nature of this work, informed consent was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tucker, N.J., Mauffrey, C. & Parry, J.A. Are pre- and postoperative true translational and angular displacement predictive of nonunion after intramedullary nail fixation of tibial shaft fractures?. Eur J Orthop Surg Traumatol 33, 37–43 (2023). https://doi.org/10.1007/s00590-021-03154-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-03154-2

Keywords

Search

Navigation