Early prediction of tibial and femoral fracture healing: Are we reliable?
BACKGROUND
To evaluate the ability of orthopaedic trauma subspecialists to predict early bony union in femoral and tibia shaft fractures.


METHODS
Eight orthopaedic trauma subspecialists prospectively predicted the probability of bony union at 6 and 12 weeks post-operatively for an aggregate of 48 femoral and tibial shaft fractures treated at a Level 1 trauma centre. An additional orthopaedic trauma subspecialist was blinded to treating surgeon and adjudicated healing at 18 weeks. The Squared-Error Skill Score (SESS) determined the likelihood of accurate forecasting for bony union.


RESULTS
Nine patients were lost follow-up, resulting in 39 fractures (81.25% retention) including 20 femoral and 19 tibial fractures. Fourteen fractures were open, 15 were not-yet united at final follow-up. SESS values were 0.25-0.77. The ability to predict union (sensitivity) was 1.000. The ability to predict nonunions (specificity) was 0.330-0.500. The probability of a correct predicted union was 0.727 and correct predicted nonunion at final follow-up was 1.000. AO/OTA type A fractures pattern predictions were highly accurate. As body mass index increased, predictions trended toward decreased accuracy (p=0.06). Tobacco use, age, gender, associated injuries, open fractures, and surgeons' years in clinical practice were not associated with accuracy of predictions.


CONCLUSIONS
At 12-weeks post-operatively orthopaedic trauma subspecialists can confidently predict the union state in this patient population. This data is most useful in the nonunion patient, directing early intervention, thereby decreasing patient disability and discomfort.
St. Alphonsus Regional Medical Center, 901 N. Curtis Rd., Ste 501, Boise, ID 83706, United States. Electronic address: esquyer@gmail.com.
Emily R
ER
Squyer
OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN, United States.
Gregory D
GD
Dikos
OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN, United States.
David M
DM
Kaehr
OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN, United States.
Dean C
DC
Maar
OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN, United States.
Renn J
RJ
Crichlow
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing / Q000502:physiology*; D005597:Fractures, Open / Q000503:physiopathology / Q000601:surgery*; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013978:Tibial Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
Bony union prediction; Femoral nonunion; Healing prediction; Tibial nonunion