OBJECTIVES

: Intramedullary nailing (IMN) is a common procedure for patients with tibial fractures requiring surgery. The technology has been utilized for > 50 years and has shown favorable outcomes. This study evaluates patient characteristics associated with postoperative complications.

METHODS

: A retrospective database analysis was conducted in the IBM® MarketScan® Commercial Database. Patients with tibial fractures during an inpatient admission with surgery requiring IMN (aka “Index”, 2010-2018) were identified. Patient demographics, comorbidities at time of index repair procedure (31 Elixhauser comorbidity indices), fracture type (open vs closed), precise fracture anatomy and postoperative complication occurrence (compartment syndrome (CS), deep infection (DI), nonunion and mechanical complication (MC)) were identified for all cases. Kaplan-Meier survival analyses and Cox proportional hazard models were built for each complication type.

RESULTS

: 11,014 patients with tibial fractures requiring IMN were identified (mean age: 38.14 (standard deviation (SD): 15.73), 36.8% female). Orthopedic risk factors (osteoporosis, rheumatoid arthritis (RA) and obesity) were present in 3.8%, 2.1% and 7.2% patients, respectively. Most patients had few comorbidities at time of index (Elixhauser index: mean: 1.44 (SD: 1.75)). At 365-days, nonunion, CS, DI and MC rates reached 13.2% (95% confidence interval (CI): 12.5%-13.9%), 1.2% (95%CI: 1.0%-1.5%), 3.3% (95%CI: 2.9%-3.6%), 6.8% (95%CI: 6.3%-7.4%) respectively. Age categories 35-44, 45-54 vs 18-24 as well as Elixhauser scores were associated with risks of nonunion (Hazard Ratio (HR): 1.50 (95%CI: 1.24-1.81 – p<0.001), 1.40 (95%CI: 1.16-1.69 – p<0.001), 1.12 (95%CI: 1.08-1.16 – p<0.001). Elixhauser scores and female sex were also associated with risk of DI (HR: 1.22 (95% CI: 1.15-1.29 – p<0.001), 0.49 (95%CI: 0.37-0.63 – p < 0.001)). CS showed an association with younger patients (Under 18 vs 18-24) and female sex (HR: 1.75, 95%CI:1.06-2.88 – p=0.028, 0.25, 95%CI: 0.14-0.42, p<0.001).

CONCLUSIONS

: Nonunion was the most common complication following tibial fractures. Comorbidities, age and sex were associated with risk of complications.