DELAYED UNIONS AND NONUNIONS OF OPEN TIBIAL FRACTURES - CORRELATION WITH ARTERIOGRAPHY RESULTS

To investigate the importance of arterial integrity in tibial fracture healing, the authors retrospectively assessed prognosis as a function of arterial injury in a large series of tibial fracture patients. The records of 114 patients who were treated for an open fracture of the tibia at a San Francisco hospital between 1981 and 1991 were selected for review; in each case, the injury had been caused by a blunt trauma , and arteriography had been performed to evaluate a suspected arteria l injury in the ipsilateral extremity. Sixty-two patients had had a no rmal arteriogram and 52 had demonstrated occlusion of one or two of th e three arteries that supply the foot. The group of patients who had d emonstrated arterial occlusion had a significantly greater incidence o f delayed union or nonunion (24 of 52 compared with ten of 62) and not ably more cases of osteomyelitis (nine of 52 compared with four of 62) ; when the patients with osteomyelitis are excluded, the difference be tween the groups is still significant. This study is the first that in dicates that patients with open fractures of the tibia who demonstrate arterial occlusion in their ipsilateral extremity may be more prone t o delayed union or nonunion. More vigilant follow-up evaluation may th erefore be warranted in such patients to better anticipate the need fo r exchange redding or bone grafting.