Risk Factors for Complications after Primary Intramedullary Nailing to Treat Tibial Shaft Fractures: A Cohort Study of 184 Consecutive Patients
Abstract
BACKGROUND
Intramedullary nailing is the standard of care for tibial shaft fractures. The risk factors for infectious and/or mechanical complications, notably non-union, remain incompletely understood. The objective of this study was to evaluate risk factors for complications, notably non-union.
HYPOTHESIS
Active smoking and an initial open wound are independent risk factors for complications.
MATERIALS AND METHODS
We retrospectively included consecutive patients managed for open or closed tibial shaft fractures by primary intramedullary nailing between 2013 and 2018. We collected data on pre-operative factors related to the patient and to the mechanism of injury (age, sex, smoking history, energy of the trauma, open wound), on intra-operative factors (residual interfragmentary gap), and on post-operative factors (early or delayed weight-bearing). We evaluated the associations between these factors and the occurrence of complications, notably non-union, by performing a univariate analysis followed by a multivariate analysis.
RESULTS
We included 184 patients (mean age, 38.5±17.6 (range, 15-91), 72.2% of males). One or more complications developed in 28 (15.2%) patients and non-union occurred in 15 (8.1 %) patients. There were three significant risk factors for complications: active smoking (OR, 7.93; 95%CI, 2.76-22.7), a residual interfragmentary gap >5 mm (OR, 4.92; 95%CI, 1.72-14.02), and an initial open wound (OR,5.16; 95%CI, 1.62-16.43) (p<0.05). The same three factors…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 184 participants or records.
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