Healing the Index Tibial Non-Union: Risk Factors for Development of a Recalcitrant Non-Union in 222 Patients.

Abstract

Objectives: to compare and stratify the healing rates after our index non-union surgery using contemporary methods of fixation, report the prevalence of recalcitrant non-union, and identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant non-union.\n\n\nDESIGN\nRetrospective analysis of a prospectively collected database.\n\n\nSETTING\nAcademic Level 1 Trauma Center.\n\n\nPATIENTS / PARTICIPANTS\n222 tibial non-unions treated with internal fixation by a single surgeon.\n\n\nINTERVENTION\nBi-variate and multi-variate regression analysis were performed to compare healing rates by the type of fixation and graft augmentation and to identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant non-union.\n\n\nRESULTS\nOf the 222 patients, 162 (73%) healed as intended, and 51 (23%) required one or more subsequent interventions to achieve union (96%). Nine fractures (4%) failed to unite. The 60 fractures (27%) that required a subsequent intervention(s) or failed to consolidate were defined as recalcitrant non-unions. There were no statistically significant differences in the recalcitrant rate when we compared plates versus nails or types of bone graft. Risk factors for developing a recalcitrant non-union were multifactorial and included, Grade III open fractures, compartment syndrome, deep infection, and two or more or more prior surgical procedures.\n\n\nCONCLUSIONS\nInternal fixation remains a successful method of treatment for most tibial non-unions. However, 27% of patients required a subsequent intervention because of failure to heal our index non-union procedure. Factors that are associated with recalcitrant non-unions were, a Grade III open fracture, compartment syndrome, deep infection, and two or more or more prior surgical procedures.\n\n\nLEVEL OF EVIDENCE\nTherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.