Treatment of delayed unions and nonunions following tibial shaft fractures: Which factors really matter?

Introduction
The aim of this study was to investigate risk factors of delayed union or nonunion of tibial shaft after fractures and its impact on the success rate their treatment.
Material & Methods
This retrospective cohort study included adult patients treated for a delayed union or nonunion following fracture of the tibial shaft at one academic Level 1 trauma center from 2012-2022. The primary outcome of the study was recalcitrant nonunion after 6 months following primary nonunion treatment; the secondary outcome was time to radiological union following primary treatment of impaired bone healing. Non-parametrical tests were implemented for comparisons between groups. Binomial logistic regression analysis was implemented to determine the risk factors that independently influenced treatment success.
Results
Overall, 59 patients (49 male; 25 delayed unions, 34 nonunion), with a median age of 38 years and a median ASA score I, were included. According to the AO/OTA classification, fracture types C3 (21 patients) and A3 (10 patients) were most common, of which 34 were open fractures. The union rate following primary nonunion treatment was 79.7% with a median time to union of 272 days. 12 recalcitrant nonunions were detected. The number of operative revisions (p=0.02) and the time interval (days) from primary fracture treatment till nonunion treatment (p=0.04) were independent risk factors for recalcitrant nonunion. The union rate was independent of age, gender, ASA score and total volume of bone defect.
Conclusions
Amount of surgeries and time delay till surgical revision treatment of delayed union/nonunion following tibial shaft fracture seem to negatively impact union rates. This underlines the importance of timely diagnosis and treatment of impaired bone healing following tibial shaft fractures.

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