title: Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients.
abstract: BACKGROUND
  Despite modern advances in the treatment of tibial shaft fractures, complications including nonunion, malunion, and infection remain relatively frequent. A better understanding of these injuries and its complications could lead to prevention rather than treatment strategies. A retrospective study was performed to identify risk factors for deep infection and compromised fracture healing after intramedullary nailing (IMN) of tibial shaft fractures.
  
  
  METHODS
  Between January 2000 and January 2012, 480 consecutive patients with 486 tibial shaft fractures were enrolled in the study. Statistical analysis was performed to determine predictors of deep infection and compromised fracture healing. Compromised fracture healing was subdivided in delayed union and nonunion. The following independent variables were selected for analysis: age, sex, smoking, obesity, diabetes, American Society of Anaesthesiologists (ASA) classification, polytrauma, fracture type, open fractures, Gustilo type, primary external fixation (EF), time to nailing (TTN) and reaming. As primary statistical evaluation we performed a univariate analysis, followed by a multiple logistic regression model.
  
  
  RESULTS
  Univariate regression analysis revealed similar risk factors for delayed union and nonunion, including fracture type, open fractures and Gustilo type. Factors affecting the occurrence of deep infection in this model were primary EF, a prolonged TTN, open fractures and Gustilo type. Multiple logistic regression analysis revealed polytrauma as the single risk factor for nonunion. With respect to delayed union, no risk factors could be identified. In the same statistical model, deep infection was correlated with primary EF.
  
  
  CONCLUSIONS
  The purpose of this study was to evaluate risk factors of poor outcome after IMN of tibial shaft fractures. The univariate regression analysis showed that the nature of complications after tibial shaft nailing could be multifactorial. This was not confirmed in a multiple logistic regression model, which only revealed polytrauma and primary EF as risk factors for nonunion and deep infection, respectively. Future strategies should focus on prevention in high-risk populations such as polytrauma patients treated with EF.
authors.affiliation: University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium. Electronic address: wilhelmus.metsemakers@uzleuven.be.
authors.forename: W-J
authors.initials: WJ
authors.lastname: Metsemakers
authors.affiliation: University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Handojo
authors.affiliation: Brugmann University Hospital, Department of Orthopaedic and Trauma Surgery, B-1000 Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Reynders
authors.affiliation: KU Leuven - University of Leuven, Department Development and Regeneration, B-3000 Leuven, Belgium; University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Sermon
authors.affiliation: KU Leuven - University of Leuven, Department Development and Regeneration, B-3000 Leuven, Belgium; University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Vanderschot
authors.affiliation: KU Leuven - University of Leuven, Department Development and Regeneration, B-3000 Leuven, Belgium; University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Nijs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005597:Fractures, Open / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Delayed union; Infection; Intramedullary nailing; Nonunion; Tibial shaft fracture