OBJECTIVES : Intramedullary nailing (IMN) is a widely used method for treating tibial fractures. This study evaluated the frequency of reoperation within one-year of initial intramedullary fixation for patients with tibial fractures and compared one-year healthcare payments among patients with and without reoperation.

METHODS: This retrospective cohort study used patient-level data from the IBM® Marketscan® Commercial database. All patients between 18-64 years who underwent fixation with an IMN for a tibial fracture between 2007-2018 were included. Reoperations were defined as presence of a second tibial surgery with known and unknown laterality within one-year of initial intramedullary fixation. Reoperations associated with non-union were also reported. Adjusted healthcare payments over one-year period were compared between patients with and without reoperations using generalized linear models with log-link function and gamma distribution.

RESULTS: A total of 6,082 patients (Mean age, 37.6 years, 37.9% female) were included in the analysis. A second tibial surgery within one year after the IMN procedure was performed in 1,463 (24.1%) patients of which 449 (7.4%) patients had records for ipsilateral reoperations and 337 (5.5%) had reoperations associated with non-union. The most common conditions for reoperations were removal of implant, complications with the implant, pain, non-union and infection. After adjusting for demographic and clinical factors, the mean payments were statistically significantly higher among patients with any reoperations ($32,607 vs $11,220), ipsilateral reoperations ($31,888 vs $11,180) and reoperations due to nonunion ($51,100 vs $11,270) as compared to patients without reoperations (All P<0.0001).

CONCLUSIONS: A high proportion of patients (24%) required a second tibial surgery after initial fixation with an IMN. Compared to patients without reoperation, patients with any or ipsilateral reoperations had healthcare payments 2.9 times higher and patients with reoperations for non-union had healthcare payments 4.5 times higher. Novel tibial nailing systems are warranted that would reduce the need for reoperation.