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Prediction of delayed union of tibial shaft fracture treated with intramedullary nailing: multicenter-study analysis and literature review -the TRON study

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

We aimed to 1) identify predictors of delayed and nonunion of tibial shaft fractures in patients treated with intramedullary nailing (IMN), including patient demographics and surgical factors, and 2) determine whether the nail/shaft ratio is associated with delayed and nonunion.

Methods

This retrospective, multicenter study included 315 patients with tibial shaft fracture treated with IMN between 2014 and 2019 and excluded patients with insufficient follow-up for 12 months, lost data and inadequate radiographs. Finally, we analyzed 258 patients (184 males; 74 females). Main outcome measurements were delayed union at 6 and nonunion at 12 months after surgery as determined on anteroposterior and lateral radiographs. We extracted the following as risk factors of delayed and nonunion: age, sex, BMI, fracture site, fracture type, injury energy, smoking history, and nail/shaft ratio. We conducted logistic regression analysis to investigate risk factors of delayed and nonunion using these extracted items as explanatory variables.

Results

Type C fracture was independently associated with delayed union (odds ratio 2.9, 95% confidential interval: 1.04–8.09, P = 0.04). Nail/shaft ratio was not an independent factor of delayed union. No independent explanatory factors were related to nonunion.

Conclusions

Type C fractures, which were unstable and fragmented, was associated with delayed union in tibia fractures treated with IMN, whereas nail thickness was not associated with delayed or nonunion fractures.

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Data availability

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

We thank Taku Watanabe, Tomoki Fujita, Takayuki Fujita, Toshifumi Sato, Fumiki Kondo, Kosuke Bando and Susumu Imai for data collection.

Funding

There is no supporting funding.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Narumi Kawasaki, Yasuhiko Takegami, Risa Sakai, Kazunori Todoroki, Ryota Uemi & Shiro Imagama

Authors
  1. Narumi Kawasaki
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  2. Yasuhiko Takegami
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  3. Risa Sakai
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  4. Kazunori Todoroki
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  5. Ryota Uemi
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  6. Shiro Imagama
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Consortia

Hospitals of Trauma Research of Nagoya (TRON) group

Contributions

YT and SI conceptualized. YT and RU oversaw the methodology. Formal analysis and investigation was conducted by RU and RS. NK wrote the original draft, YT has performed the editing and review. Data provided by the Hospitals team. SI supervised the research. YT and KT reviewed and edited the draft.

Corresponding author

Correspondence to Yasuhiko Takegami.

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Conflict of interest

The author(s) declare that they have no competing interests.

Consent for publication

All patients provided written informed for their data to be used.

Ethical approval

The approval number in our institute is 2020–0190.

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The collaborators members of the Hospitals of Trauma Research of Nagoya (TRON) group are listed in “Appendix”.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 KB)

Appendix

Appendix

Member of the TRON (sown in alphabetical order of affiliation) are as follows; Dr. Takeshi Oguchi (Anjo Kosei Hospital), Dr. Yoshiharu Oka (Chubu Rosai Hospital), Dr. Tetsuro Takatsu(Gifu Prefectural Tajimi Hospital), Dr. Kazuyoshi Miyasaka (Handa City Hospital), Dr. Hiroyuki Matsubara (Hekinan Municipal Hospital), Dr. Hiroaki Kumagai (Nagoya Ekisaikai Hospital), Dr. Toshihiro Ando (Nagoya Daini Red Cross Hospital), Dr. Kenichi Yamauchi (Toyohashi Municipal Hospital), Dr. Yasuhide Kanayama (Toyota Kosei Hospital) and Dr. Tadahiro Sakai (TOYOTA memorial Hospital).

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Kawasaki, N., Takegami, Y., Sakai, R. et al. Prediction of delayed union of tibial shaft fracture treated with intramedullary nailing: multicenter-study analysis and literature review -the TRON study. Eur J Orthop Surg Traumatol 32, 129–135 (2022). https://doi.org/10.1007/s00590-021-02939-9

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  • DOI: https://doi.org/10.1007/s00590-021-02939-9

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