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Risk Factors for Tibial Plafond Nonunion: Medial Column Fixation May Reduce Nonunion Rates.
- Source :
-
Journal of orthopaedic trauma [J Orthop Trauma] 2019 Sep; Vol. 33 (9), pp. 443-449. - Publication Year :
- 2019
-
Abstract
- Objectives: To identify the incidence and risk factors for development of tibial plafond nonunion.<br />Design: Retrospective comparative study.<br />Setting: Two Level 1 academic trauma centers.<br />Patients/participants: Seven hundred forty tibial plafond fractures (OTA/AO 43B3 and 43C) treated January 2006 to December 2015.<br />Intervention: Open reduction and internal fixation.<br />Main Outcome Measurement: Nonunion.<br />Results: Five hundred eighteen patients with a mean age of 43 years (range, 18-81 years) and mean follow-up of 27 months (range, 12-115 months) were involved. Seventy-two patients (72/518, 14%) were identified as having a nonunion. Surgical approach was not associated with nonunion in univariate analysis. Multiple regression model 1 identified OTA/AO 43C [odds ratio (OR) = 4.43; 95% confidence interval (CI), 1.01-19.41; P = 0.048], tobacco use (OR = 2.02; 95% CI, 1.10-3.71; P = 0.024), both minimal and substantial bone loss (P = 0.006 and P < 0.001, respectively), and open fracture (OR = 1.96; 95% CI, 1.10-3.48; P = 0.022) as risk factors for tibial plafond nonunion. Model 2 identified locking plate (OR = 1.97; 95% CI, 1.13-3.40; P = 0.016) and failure to treat the medial column (vs. screw P = 0.047, or plate P = 0.038) as risk factors.<br />Conclusions: The tibial plafond nonunion rate was 14%. Bone loss, open fracture, failure to treat the medial column, locking plates, and tobacco use were all significant risk factors for developing tibial plafond nonunion. Equally important, surgical approach was not significantly associated with plafond nonunion.<br />Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Incidence
Male
Middle Aged
Retrospective Studies
Risk Factors
Young Adult
Fracture Fixation, Internal
Fractures, Ununited epidemiology
Fractures, Ununited prevention & control
Open Fracture Reduction
Postoperative Complications epidemiology
Postoperative Complications prevention & control
Tibial Fractures surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1531-2291
- Volume :
- 33
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal of orthopaedic trauma
- Publication Type :
- Academic Journal
- Accession number :
- 31094937
- Full Text :
- https://doi.org/10.1097/BOT.0000000000001500