Causation Analysis Of Post-traumatic Tibial Nonunion

Objective:The incidence rate of the tibial nonunion is common frequently.The pain,physical function and psychological barriers to patients after tibial nonunion brought great suffering and economic burden which seriously affect quality of life.This paper reviews the study of post-traumatic tibial nonunion occur with age,AIS/ISS(2005 version),fracture type,24h in blood glucose, alkaline phosphatase,calcium,phosphorus and magnesium,and further analysis the relationship between the incidence of nonunion and medical complications, fracture site,fracture treatment,which can guide the clinical treatment of the right tibial nonunion high-risk groups,and reduce the incidence of nonunion.Methods: Reviewed patient of tibial diaphysis fractures in the trauma care center of the Third Hospital of Hebei Medical University,in January 2010 ~ March 2010,and patient's age, fracture type and location, fracture treatment, AIS-ISS score, 24h blood glucose, alkaline phosphatase, calcium, phosphorus and magnesium content. Through telephone follow-up fracture healing:①local standard : no local abnormal activities, no pain, tenderness and vertical percussion;②iconography standard: X-ray imaging shows fracture line blurred, there is a continuous callus through the fracture line;③function standard :patients can continuous walk in 3 minutes after removing external fixator without crutches (≥30 steps), and the fracture is not deformation observed for 2 weeks. According to the U.S. Food and Drug Administration (Food and Drug Administration, FDA) established diagnostic criteria for nonunion, the fracture has not healed after 9 months and has 3 consecutive months without any signs of healing, fractures of the tibia were divided 2 groups:①the observation group: nonunion,②control group:fracture healing. Compare whether or not the mean±standard deviation of the age, AIS score, ISS score 24h blood glucose,alkaline phosphatase,calcium, phosphorus, magnesium content in two groups existence significant differences ,and compare between the two groups whether or not the open fracture rates existence the significant difference combined with clinical Analysis of tibial nonunion reasons.Result:1 In this study, 52 cases of tibial fracture patients include criteria, 9 cases of nonunion,43 cases of healing.Age of nonunion group (37.78±15.99Y)greater than the fracture healing group (31.63±17.35Y),but no significant difference(P>0.05),AIS score of nonunion group (2.67±0.50) greater than the fracture healing Group (2.58±0.50),no significant difference (P>0.05),ISS score nonunion group(10.9±3.6)than fracture healing group (7.7±4.0),were significantly different (P<0.05).2 alkaline phosphatase in peripheral blood in 24h in nonunion of group (73.0±27.4U/L) is greater than the fracture healing group (63.2±31.9U/L),no significant statistical difference (P>0.05),calcium content in peripheral blood in 24h in nonunion of group (2.06±0.29mmol/L) is greater than fracture healing group (2.01±0.18mmol/L),phosphorus content of nonunion group (1.11±0.17mmol/L)less than the fracturehealing group (1.17±0.23mmol /L),Magnesium content of nonunion group (0.81±0.05mmol/L)is greater than fracture healing group (0.79±0.10mmol/L),There were nosignificant differences(P> 0.05);blood glucose in peripheral blood in 24h in nonunion group(7.45±3.18mmol/L) is greater than the fracture healing group(6.11±0.97 mmol/L),which were significantly different(P<0.05).3 fracture type,9 cases of the nonunion group:closed fracture in 2 cases,according to AO type,1 case of A type,1 case of B type,7 cases of the open fracture.In according to Gustilo-Anderson type,1 case of,Ⅱ,ⅢA type,2 cases ofⅢB,ⅢC type;43 cases in fracture healing group:closed fracture in 32 cases,according to AO type, 18 cases of A type,11 cases of B type,2 cases of C type,open fracture in 11 cases.According to Gustilo-Anderson type 4 cases of typeⅠ,2 cases of typeⅡ,3 cases of typeⅢA, 2 cases of typeⅢC. After statistical analysis,open fracture rate in nonunion group (13.5%) more than that in fracture healing group (3.8%), the results were significantly different (P <0.05).Conclusions:It is a relatively long healing process for the fracture healing. Many factors affect the fracture healing, such as the systemic factors of patients ,the local factors of patients'fracture injury, and the iatrogenic factors. All can affect the process and lead to the occurrence of the bone's nonunion. The study found that the post-traumatic tibial nonunion is not clearly connected to patients'age, the AIS score of the fracture site, 24h blood alkaline phosphatase, calcium, phosphorus and magnesium. The Tibial nonunion is positively correlated with the open fractures, the ISS score and the 24 blood sugar which help the clinical orthopedic surgeon to prevent the occurrence of nonunion well.