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J Bone Joint Surg Am. 2012 Oct 3;94(19):1786-93. doi: 10.2106/JBJS.J.01418.

Prognostic factors for predicting outcomes after intramedullary nailing of the tibia.

Collaborators (272)

Bhandari M, Guyatt G, Guyatt G, Bhandari M, Sanders DW, Schemitsch EH, Swiontkowski M, Tornetta P 3rd, Walter SD, Guyatt G, Bhandari M, Sanders DW, Schemitsch EH, Swiontkowski M, Tornetta P 3rd, Walter SD, Sprague S, Heels-Ansdell D, Buckingham L, Leece P, Viveiros H, Mignott T, Ansell N, Sidorkewicz N, Agel J, Bombardier C, Berlin JA, Bosse M, Browner B, Gillespie B, Jones A, O'Brien P, Agel J, Sprague S, Poolman R, Bhandari M, Kreder HJ, Stephen DJ, Axelrod TS, Yee AJ, Richards RR, Finkelstein J, Gofton W, Murnaghan J, Schatztker J, Ford M, Bulmer B, Conlan L, Laflamme G, Berry G, Beaumont P, Ranger P, Laflamme GH, Gagnon S, Malo M, Fernandes J, Poirier MF, Schemitsch EH, McKee MD, Waddell JP, Bogoch ER, Daniels TR, McBroom RR, Vicente MR, Storey W, Wild LM, McCormack R, Perey B, Goetz TJ, Pate G, Penner MJ, Panagiotopoulos K, Pirani S, Dommisse IG, Loomer RL, Stone T, Moon K, Zomar M, Webb LX, Teasdall RD, Birkedal JP, Martin DF, Ruch DS, Kilgus DJ, Pollock DC, Harris MB, Wiesler ER, Ward WG, Shilt JS, Koman AL, Poehling GG, Kulp B, Tornetta P 3rd, Creevy WR, Stein AB, Bono CT, Einhorn TA, Brown D, Pacicca D, Sledge JB 3rd, Foster TE, Voloshin I, Bolton J, Carlisle H, Shaughnessy L, Obremskey WT, LeCroy C, Meinberg EG, Messer TM, Craig WL 3rd, Dirschl DR, Caudle R, Harris T, Elhert K, Hage W, Jones R, Piedrahita L, Schricker PO, Driver R, Godwin J, Obremskey WT, Kregor PJ, Tennent G, Truchan LM, Sciadini M, Shuler FD, Driver RE, Nading MA, Neiderstadt J, Vap AR, Vallier HA, Patterson BM, Wilber JH, Wilber RG, Sontich JK, Moore TA, Brady D, Cooperman DR, Davis JA, Cureton BA, Mandel S, Orr R, Sadler JT, Hussain T, Rajaratnam K, Petrisor B, Bhandari M, Drew B, Bednar DA, Kwok DC, Pettit S, Hancock J, Sidorkewicz N, Cole PA, Smith JJ, Brown GA, Lange TA, Stark JG, Levy BA, Swiontkowski MF, Garaghty MJ, Salzman JG, Schutte CA, Tastad L, Vang S, Seligson D, Roberts CS, Malkani AL, Sanders L, Dyer C, Heinsen J, Smith L, Madanagopal S, Frantz-Bush L, Coupe KJ, Tucker JJ, Criswell AR, Buckle R, Rechter AJ, Sheth DS, Urquart B, Trotscher T, Anders MJ, Kowalski JM, Fineberg MS, Bone LB, Phillips MJ, Rohrbacher B, Stegemann P, Mihalko WM, Buyea C, Augustine SJ, Jackson WT, Solis G, Ero U, Segina DN, Berrey HB, Agnew SG, Fitzpatrick M, Campbell LC, Derting L, McAdams J, Goslings J, Ponsen KJ, Kloen P, Joosse P, Winkelhagen J, Duivenvoorden R, Teague DC, Davey J, Sullivan J, Ertl WJ, Puckett TA, Pasque CB, Tompkins JF 2nd, Gruel CR, Kammerlocher P, Lehman TP, Puffinbarger WR, Carl KL, Weber DW, Jomha NM, Goplen GR, Masson E, A L, Schaump LN, Jeray KJ, Goetz DR, Westberry DE, Broderick J, Moon BS, Tanner SL, Powell JN, Buckley RE, Elves L, John S, Connolly S, Abraham EP, Steele T, Ellis T, Herzberg A, Brown GA, Crawford DE, Hart R, Hayden J, Orfaly RM, Vigland T, Vivekaraj M, Bundy GL, Miclau T 3rd, Matityahu A, Coughlin R, Kandemir U, McClellan R, Lin CH, Karges D, Cramer K, Watson J, Moed B, Scott B, Beck DJ, Orth C, Puskas D, Clark R, Jones J, Egol KA, Paksima N, Wai EK, Johnson G, Wilkinson R, Gruszczynski AT, Vexler L.

Abstract

BACKGROUND:

Prediction of negative postoperative outcomes after long-bone fracture treatment may help to optimize patient care. We recently completed the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT), a large, multicenter trial of reamed and unreamed intramedullary nailing of tibial shaft fractures in 1226 patients. Using the SPRINT data, we conducted an investigation of baseline and surgical factors to determine any associations with an increased risk of adverse events within one year of intramedullary nailing.

METHODS:

Using multivariable logistic regression analysis, we investigated fifteen baseline and surgical factors for any associations with an increased risk of negative outcomes.

RESULTS:

There was an increased risk of negative events in patients with a high-energy mechanism of injury (odds ratio [OR] = 1.57; 95% confidence interval [CI], 1.05 to 2.35), a stainless steel compared with a titanium nail (OR = 1.52; 95% CI, 1.10 to 2.13), a fracture gap (OR = 2.40; 95% CI, 1.47 to 3.94), and full weight-bearing status after surgery (OR = 1.63; 95% CI, 1.00 to 2.64). There was no increased risk with the use of nonsteroidal anti-inflammatory agents, late or early time to surgery, or smoking status. Open fractures had a higher risk of events among patients treated with reamed nailing (OR = 3.26; 95% CI, 2.01 to 5.28) but not in patients treated with unreamed nailing (OR = 1.50; 95% CI, 0.92 to 2.47). Patients with open fractures who had wound management either without any additional procedures or with delayed primary closure had a decreased risk of events compared with patients who required subsequent, more complex reconstruction (OR = 0.18 [95% CI, 0.09 to 0.35] and 0.29 [95% CI, 0.14 to 0.62], respectively).

CONCLUSIONS:

We identified several baseline fracture and surgical characteristics that may increase the risk of adverse events in patients with tibial shaft fractures. Surgeons should consider the predictors identified in our analysis to inform patients treated for tibial shaft fractures.

LEVEL OF EVIDENCE:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:
23032589
[PubMed - indexed for MEDLINE]
PMCID:
PMC3448300
Free PMC Article
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