Document Detail


Prognostic factors for predicting outcomes after intramedullary nailing of the tibia.
MedLine Citation:
PMID:  23032589     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Prediction of negative postoperative outcomes after long-bone fracture treatment may help to optimize patient care. We recently completed the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT), a large, multicenter trial of reamed and unreamed intramedullary nailing of tibial shaft fractures in 1226 patients. Using the SPRINT data, we conducted an investigation of baseline and surgical factors to determine any associations with an increased risk of adverse events within one year of intramedullary nailing.
METHODS: Using multivariable logistic regression analysis, we investigated fifteen baseline and surgical factors for any associations with an increased risk of negative outcomes.
RESULTS: There was an increased risk of negative events in patients with a high-energy mechanism of injury (odds ratio [OR] = 1.57; 95% confidence interval [CI], 1.05 to 2.35), a stainless steel compared with a titanium nail (OR = 1.52; 95% CI, 1.10 to 2.13), a fracture gap (OR = 2.40; 95% CI, 1.47 to 3.94), and full weight-bearing status after surgery (OR = 1.63; 95% CI, 1.00 to 2.64). There was no increased risk with the use of nonsteroidal anti-inflammatory agents, late or early time to surgery, or smoking status. Open fractures had a higher risk of events among patients treated with reamed nailing (OR = 3.26; 95% CI, 2.01 to 5.28) but not in patients treated with unreamed nailing (OR = 1.50; 95% CI, 0.92 to 2.47). Patients with open fractures who had wound management either without any additional procedures or with delayed primary closure had a decreased risk of events compared with patients who required subsequent, more complex reconstruction (OR = 0.18 [95% CI, 0.09 to 0.35] and 0.29 [95% CI, 0.14 to 0.62], respectively).
CONCLUSIONS: We identified several baseline fracture and surgical characteristics that may increase the risk of adverse events in patients with tibial shaft fractures. Surgeons should consider the predictors identified in our analysis to inform patients treated for tibial shaft fractures.
LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Authors:
Emil H Schemitsch; Mohit Bhandari; Gordon Guyatt; David W Sanders; Marc Swiontkowski; Paul Tornetta; Stephen D Walter; Rad Zdero; J C Goslings; David Teague; Kyle Jeray; Michael D McKee;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  94     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-03     Completed Date:  2012-12-17     Revised Date:  2013-10-09    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1786-93     Citation Subset:  AIM; IM    
Affiliation:
Division of Orthopaedics, Department of Surgery, University of Toronto, St. Michael's Hospital, Suite 800, 55 Queen Street East, Toronto, ON M5C 1R6, Canada. schemitsche@smh.ca
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MeSH Terms
Descriptor/Qualifier:
Adult
Bone Nails*
Confidence Intervals
Female
Fracture Fixation, Intramedullary / adverse effects,  methods*
Fracture Healing / physiology*
Humans
Injury Severity Score
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Ontario
Pain Measurement
Patient Selection
Postoperative Care / methods
Postoperative Complications / physiopathology,  radiography
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Tibial Fractures / radiography,  surgery*
Treatment Outcome
Weight-Bearing
Young Adult
Grant Support
ID/Acronym/Agency:
MCT-38140//Canadian Institutes of Health Research; NIAMS-072//PHS HHS; R01-AR48529/AR/NIAMS NIH HHS
Investigator
Investigator/Affiliation:
Mohit Bhandari / ; Gordon Guyatt / ; Gordon Guyatt / ; Mohit Bhandari / ; David W Sanders / ; Emil H Schemitsch / ; Marc Swiontkowski / ; Paul Tornetta / ; Stephen D Walter / ; Gordon Guyatt / ; Mohit Bhandari / ; David W Sanders / ; Emil H Schemitsch / ; Marc Swiontkowski / ; Paul Tornetta / ; Stephen D Walter / ; Sheila Sprague / ; Diane Heels-Ansdell / ; Lisa Buckingham / ; Pamela Leece / ; Helena Viveiros / ; Tashay Mignott / ; Natalie Ansell / ; Natalie Sidorkewicz / ; Julie Agel / ; Claire Bombardier / ; Jesse A Berlin / ; Michael Bosse / ; Bruce Browner / ; Brenda Gillespie / ; Alan Jones / ; Peter O'Brien / ; Julie Agel / ; Sheila Sprague / ; Rudolf Poolman / ; Mohit Bhandari / ; Hans J Kreder / ; David J G Stephen / ; Terry S Axelrod / ; Albert J M Yee / ; Robin R Richards / ; Joel Finkelstein / ; Wade Gofton / ; John Murnaghan / ; Joseph Schatztker / ; Michael Ford / ; Beverly Bulmer / ; Lisa Conlan / ; G Yves Laflamme / ; Gregory Berry / ; Pierre Beaumont / ; Pierre Ranger / ; Georges-Henri Laflamme / ; Sylvain Gagnon / ; Michel Malo / ; Julio Fernandes / ; Marie-France Poirier / ; Emil H Schemitsch / ; Michael D McKee / ; James P Waddell / ; Earl R Bogoch / ; Timothy R Daniels / ; Robert R McBroom / ; Milena R Vicente / ; Wendy Storey / ; Lisa M Wild / ; Robert McCormack / ; Bertrand Perey / ; Thomas J Goetz / ; Graham Pate / ; Murray J Penner / ; Kostas Panagiotopoulos / ; Shafique Pirani / ; Ian G Dommisse / ; Richard L Loomer / ; Trevor Stone / ; Karyn Moon / ; Mauri Zomar / ; Lawrence X Webb / ; Robert D Teasdall / ; John Peter Birkedal / ; David Franklin Martin / ; David S Ruch / ; Douglas J Kilgus / ; David C Pollock / ; Mitchel Brion Harris / ; Ethan Ron Wiesler / ; William G Ward / ; Jeffrey Scott Shilt / ; Andrew L Koman / ; Gary G Poehling / ; Brenda Kulp / ; Paul Tornetta / ; William R Creevy / ; Andrew B Stein / ; Christopher T Bono / ; Thomas A Einhorn / ; Desmond Brown / ; Donna Pacicca / ; John B Sledge / ; Timothy E Foster / ; Ilva Voloshin / ; Jill Bolton / ; Hope Carlisle / ; Lisa Shaughnessy / ; William T Obremskey / ; C Michael LeCroy / ; Eric G Meinberg / ; Terry M Messer / ; William L Craig / ; Douglas R Dirschl / ; Robert Caudle / ; Tim Harris / ; Kurt Elhert / ; William Hage / ; Robert Jones / ; Luis Piedrahita / ; Paul O Schricker / ; Robin Driver / ; Jean Godwin / ; William T Obremskey / ; Philip James Kregor / ; Gregory Tennent / ; Lisa M Truchan / ; Marcus Sciadini / ; Franklin D Shuler / ; Robin E Driver / ; Mary Alice Nading / ; Jacky Neiderstadt / ; Alexander R Vap / ; Heather A Vallier / ; Brendan M Patterson / ; John H Wilber / ; Roger G Wilber / ; John K Sontich / ; Timothy Alan Moore / ; Drew Brady / ; Daniel R Cooperman / ; John A Davis / ; Beth Ann Cureton / ; Scott Mandel / ; R Douglas Orr / ; John T S Sadler / ; Tousief Hussain / ; Krishan Rajaratnam / ; Bradley Petrisor / ; Mohit Bhandari / ; Brian Drew / ; Drew A Bednar / ; Desmond C H Kwok / ; Shirley Pettit / ; Jill Hancock / ; Natalie Sidorkewicz / ; Peter A Cole / ; Joel J Smith / ; Gregory A Brown / ; Thomas A Lange / ; John G Stark / ; Bruce A Levy / ; Marc F Swiontkowski / ; Mary J Garaghty / ; Joshua G Salzman / ; Carol A Schutte / ; Linda Tastad / ; Sandy Vang / ; David Seligson / ; Craig S Roberts / ; Arthur L Malkani / ; Laura Sanders / ; Carmen Dyer / ; Jessica Heinsen / ; Langan Smith / ; Sudhakar Madanagopal / ; Linda Frantz-Bush / ; Kevin J Coupe / ; Jeffrey J Tucker / ; Allen R Criswell / ; Rosemary Buckle / ; Alan Jeffrey Rechter / ; Dhiren Shaskikant Sheth / ; Brad Urquart / ; Thea Trotscher / ; Mark J Anders / ; Joseph M Kowalski / ; Marc S Fineberg / ; Lawrence B Bone / ; Matthew J Phillips / ; Bernard Rohrbacher / ; Philip Stegemann / ; William M Mihalko / ; Cathy Buyea / ; Stephen J Augustine / ; William Thomas Jackson / ; Gregory Solis / ; U Ero / ; Daniel N Segina / ; Hudson B Berrey / ; Samuel G Agnew / ; Michael Fitzpatrick / ; Lakina C Campbell / ; Lynn Derting / ; June McAdams / ; J Carel Goslings / ; Kees Jan Ponsen / ; Peter Kloen / ; Pieter Joosse / ; Jasper Winkelhagen / ; Raphäel Duivenvoorden / ; David C Teague / ; Joseph Davey / ; J Andy Sullivan / ; William J J Ertl / ; Timothy A Puckett / ; Charles B Pasque / ; John F Tompkins / ; Curtis R Gruel / ; Paul Kammerlocher / ; Thomas P Lehman / ; William R Puffinbarger / ; Kathy L Carl / ; Donald W Weber / ; Nadr M Jomha / ; Gordon R Goplen / ; Edward Masson / ; Lauren A / ; Lori N Schaump / ; Kyle J Jeray / ; David R Goetz / ; David E Westberry / ; J Scott Broderick / ; Bryan S Moon / ; Stephanie L Tanner / ; James N Powell / ; Richard E Buckley / ; Leslie Elves / ; Saint John / ; Stephen Connolly / ; Edward P Abraham / ; Trudy Steele / ; Thomas Ellis / ; Alex Herzberg / ; George A Brown / ; Dennis E Crawford / ; Robert Hart / ; James Hayden / ; Robert M Orfaly / ; Theodore Vigland / ; Maharani Vivekaraj / ; Gina L Bundy / ; Theodore Miclau / ; Amir Matityahu / ; R Richard Coughlin / ; Utku Kandemir / ; R Trigg McClellan / ; Cindy Hsin-Hua Lin / ; David Karges / ; Kathryn Cramer / ; J Tracy Watson / ; Berton Moed / ; Barbara Scott / ; Dennis J Beck / ; Carolyn Orth / ; David Puskas / ; Russell Clark / ; Jennifer Jones / ; Kenneth A Egol / ; Nader Paksima / ; Eugene K Wai / ; Garth Johnson / ; Ross Wilkinson / ; Adam T Gruszczynski / ; Liisa Vexler /
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