The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures

This study was conducted to determine retrospectively the factors which inf luence fracture healing and risk for nonunion in patients with tibial shaft fractures. One hundred consecutive patients with 104 tibial shaft fracture s and a mean age of 40 (14-85) years were reviewed. Fractures were classifi ed according to the AO classification system. There were 22 open fractures and 52 comminuted fractures. Thirty-eight fractures were caused by high-ene rgy trauma. Fracture pattern, soft-tissue condition, level of energy of the trauma, malalignment, and treatment methods were identified. The influence of these factors on the time of hospital stay and sick-leave, delayed unio n, and nonunion were calculated. Normal healing occurred in 61 fractures wi th a mean healing time of 17 weeks, delayed union in 27 with a mean of 35 w eeks, and nonunion in 16 with a mean of 69 weeks. The relative risk of deve loping nonunion in open fractures was 8.2 (CI = 2.9-10.5) and 2.9 (CI = 1.2 -3.2) in fractures exposed to high-energy trauma. This study showed that th e soft-tissue condition and level of trauma energy are good predictors for the development of complications. Considering these risk factors at an earl y stage in the planning of treatment might reduce the risk of nonunion.