Risk Factors For Nonunion Of Closed Tibial Shaft Fractures

Objectives The study intends to analyze and compare patients with clinically closed tibial shaft fracture healing and nonunion,exploring the influence of gender,age,injury mechanism,fracture site,fracture displacement,fixation,anemia,albumin level,lymphocyte level,internal fixation,smoking status,NSAID use,diabetes,triglyceride levels,cholesterol level on the healing of closed tibial shaft fractures.Determining the possible risk factors for nonunion of closed tibial shaft fractures,thus,certain reference points are raised for the clinic.Methods We retrospectively analyzed datas from 197 patients with tibial shaft fracture by drawing upon samples from Orthopaedic Department of The Affiliated Hospital of North China University Of Science And Technology and The Second Hospital Of Tangshan during May 2014 to April 2016.Categorical variables(Gender,Age,Injury Mechanism,Fracture Site,Fracture displacement,Fixation,Anemia,Albumin Level,Lymphocyte Level,Internal fixation,Smoking status,NSAID Use,Diabetes,Triglyceride Levels,Cholesterol level)were described by percentage(N%)and chi-squared test was applied for the comparison of categorical variables.The variables that have different differences between groups are further introduced into the Logistic multi-element linear regression model,the study observes the Odds Ratio and its confidence interval for factors affecting nonunion of humeral shaft fractures,the P<0.05(bilateral)factor was considered as an independent risk factor.Results Of the 197 patients with closed tibial shaft fractures,171 patients were identified to have healing of fracture of closed tibia,the prevalence of healing was 86.80%,26 patients were identified to have nonunion of fracture of tibia,the prevalence of nonunion was 13.20%,Chi-square test showed that the prevalence of the closed tibial fracture nonunion was statistically significant among the injury mechanism,fracture displacement,fixation,open or not,fractures,albumin groups,lymphocytes groups,diabetes,smoking,anemia.Different meaningful variables were imported into multivariate logistic linear regression model for further analysis,which multivariate logistic regression model showed that: nine factors were independently associated with the occurrence of tibial shaft fracture nonunion,including diabetes,OR value was 5.412(95%CI : 1.473~19.888);Lymphocyte count <1.5 × 109 / L,OR value was 6.506(95%CI:1.579~26.799);Albumin <35g / L,OR value was 8.658(95%CI : 2.080~36.036);Mid / distal fracture,OR value was 4.844(95%CI:1.185~19.809);High energy damage,OR value was 4.844(95%CI:1.185~19.809);Ordinary plate fixed,OR value was 6.892(95%CI:1.170~40.603);Smoking,OR value was 7.148(95%CI:1.681~30.390);open reduction,OR value was 5.829(95%CI:1.576~21.563);anemi,OR value was 5.186(95%CI:1.212~22.191).Conclusions The causes of non-union of closed tibial shaft fractures are complex and are the result of a combination of various factors.Diabetes,distal fracture(fracture / parts),high energy injury(injury),smoking,open reduction,poor nutritional status(albumin level or lymphocyte level < 35g/l < 1.5*109/L or anemia),treatment of ordinary plate fixation(fixation)all had a certain effect on non-union of tibial shaft fractures and were independent risk factors of nonunion of tibial shaft fracture.Sort by their degree of risk(OR),as followed Albumin levels,smoking,lymphocyte levels,injury mechanisms,reduction mode,diabete,anemia,fracture sites,fixation methods,.