Analysis of delayed fracture healing following unreamed tibial nailing
Salem, Khaled Hamed
LicenseStandard (Fassung vom 03.05.2003)
In order to determine the factors that affect tibial fracture union after unreamed nailing and the variables that have a negative impact on the healing process or the complication rate, 158 patients with 160 tibial shaft fractures treated using the AO Unreamed Tibial Nail (UTN®) were retrospectively reviewed. There were 105 men and 53 women with a mean age of 39,5 years. Fractures were classified using the AO classification into 78 type A fractures, 65 type B fractures, and 17 type C fractures. Fracture comminution was classified using Winquist criteria. There were 115 closed and 45 open fractures. Nearly two-thirds of the fractures were caused by high-energy trauma. Fracture union occurred after a mean time of 24,3 weeks. There were 20 cases of delayed union and 16 non-unions, all united by the end of treatment. There were remarkably few soft tissue complications with a very low deep infection rate. Fatigue failure of the locking screws continues to be a major complication. The most important variables affecting fracture healing in this study were the mechanism of trauma, fracture site gap, and the time to dynamization. With a 10 % significance level, the variables associated with a higher risk of delayed or non-union were the degree of comminution, fracture site gap, and most importantly, the time to dynamization. Fracture comminution and high energy trauma were the main factors associated with a higher risk for malunion. The odds were 5 times more with high comminution and 13 times more with high-energy falls than with low comminution and low-energy falls respectively. The risk of fatigue failure of the locking screws was highest for 3,9 mm screws used in 9 mm nails. Although not statistically significant because of the small sample size, proximal tibial fractures showed a general tendency for a less than favorable outcome with unreamed nailing.
Subject HeadingsNagelung [GND]
Fracture healing [MeSH]
Tibial fractures [MeSH]