Prediction of tibial nonunion at the 6-week time point

Keir A. Ross, Kevin O'Halloran, Renan C. Castillo, Max Coale, Justin Fowler, Jason W. Nascone, Marcus F. Sciadini, Christopher T. LeBrun, Theodore T. Manson, Anthony R. Carlini, Josef E. Jolissaint, Robert V. O'Toole

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Introduction: Intramedullary (IM) nail fixation is a common operative treatment, yet concerns regarding the frequency of complications, such as nonunion, remain. Treatment of tibial shaft fractures remains a challenge, and little evidence of prognostic factors that increase risk of nonunion is available. The aim of this study was to develop a predictive model of tibial shaft fracture nonunion 6 weeks after reamed intramedullary (IM) nail fixation based on commonly collected clinical variables and the radiographic union score for tibial fractures (RUST). Methods: A retrospective case-control study was conducted. All tibial shaft fractures treated at our level I trauma center from 2007 to 2014 were retrospectively reviewed. Only patients with follow-up until fracture healing or secondary operation for nonunion were included. Fracture gaps ≥3 mm were excluded. A total of 323 patients were included for study. Results: Infection within 6 weeks of operation, standard RUST, and the Nonunion Risk Determination (NURD) score had statistically significant associations with nonunion (odds ratio > or < 1.0; p < 0.01). The NURD score was increasingly predictive of nonunion with decreasing RUST. All patients in the high RUST group (RUST ≥ 10), achieved union regardless of NURD score. In the medium RUST group (RUST 6–9), 25% of patients with a NURD score ≥7 experienced nonunion. In the low RUST group (RUST <6 or infection within 6 weeks), 69% of patients with a NURD score ≥7 experienced nonunion. Conclusion: Three variables predicted nonunion. Based on these variables, we created a clinical prediction tool of nonunion that could aid in clinical decision making and discussing prognosis with patients.

Original languageEnglish (US)
Pages (from-to)2075-2082
Number of pages8
Issue number11
StatePublished - Nov 2018
Externally publishedYes


  • Intramedullary nail
  • Nonunion
  • Prediction model
  • Tibia
  • Tibial fracture

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine


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