Factors associated with treatment failure of aseptic tibial nonunions managed by circular external fixation

Abstract

Background: Tibial nonunions pose significant treatment challenges despite the regularity with which they are encountered. While several studies have reported the outcome of treating different nonunion subtypes with various strategies, few have investigated the factors that influence treatment and outcome. Aims: This study aims to identify factors that complicate the management of uninfected tibial nonunions and are associated with failure of treatment. Materials and Methods: We retrospectively reviewed all patients with uninfected tibial nonunions who were treated according to a standardized treatment algorithm over a 5-year period. Results: The final cohort consisted of 84 patients with a mean age of 36.5 years (range 5–68 years). Bony union was achieved in 79 out of 84 (94%) tibias. Malalignment (P < 0.001), smoking (P = 0.008), alcohol use (P = 0.039), and time from injury to nonunion management (P = 0.003) were found to be associated with treatment failure. The factors found to be associated with increased treatment complexity were smoking (P = 0.035), alcohol use (P = 0.011), and time from injury to nonunion management (P < 0.001). Conclusion: General orthopedic surgeons should, therefore, refer these patients to reconstructive surgeons as soon as the diagnosis of a tibial nonunion is made while reconstructive surgeons should note the importance of host optimization and mechanical alignment during the management of these conditions.