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Use of anti-inflammatories post-operatively
1%
14/1305
Post-operative gapping at the fracture site
50%
659/1305
Presence of an associated fibular fracture
17/1305
History of smoking
45%
585/1305
Mechanism of injury
2%
21/1305
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Post-operative gapping at the fracture site significantly increased the risk of reoperation due to nonunion or malunion. Bhandari et al performed a retrospective study to identify which prognostic factors were associated with an increased risk of reoperation for nonunion in surgically treated tibial shaft fractures. They examined over 200 fractures, and found the presence of an open fracture wound (RR 4.32), lack of cortical continuity between the fracture ends following fixation (RR 8.33), and the presence of a transverse fracture (RR 20.0) were the three variables most predicitive of reoperation. Audige et al analyzed 416 patients with operatively treated tibial shaft fractures who were followed for at least 6 months. They found that the greatest risk for delayed healing or nonunion was the presence of an open injury, fractures of the distal 1/3 of the tibia, and postoperative gapping at the fracture site (The risk of healing problems was doubled for fractures of the distal shaft and for fractures showing a postoperative diastasis).
3.1
(42)
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