OBJECTIVES: Tibial fractures are more likely to occur secondary to osteoporosis than any other fractures. Intramedullary nailing (IMN) is a widely used method for treating tibial fractures. This study assessed the complications, reoperations and reimbursement associated with these within one-year of IMN in tibial fractures for patients with osteoporosis or osteopenia, representing poor bone quality.

METHODS: This retrospective cohort study used the IBM® Marketscan® Commercial database from 2007-2018. All patients with a diagnosis of osteoporosis or osteopenia between 18-64 years who underwent fixation with an intramedullary implant for a tibial fracture were included. Proportion of patients with complications including non-union, malunion, deep infection and mechanical complications along with reoperations within one-year of IMN were reported. Adjusted reimbursements over one-year period were compared between patients with and without the top two complications and reoperations using generalized linear models with log-link function and gamma distribution.

RESULTS: A total of 225 patients (Mean [SD] age, 50.3 [13.6] years, 75.6% female) with osteoporosis or osteopenia requiring IMN for tibial fractures were included in the analysis. Over the one-year period after IMN, 15.1% had nonunion, 7.6% had mechanical complications, 4.4% had deep infection and 1.3% had malunion. Reoperations were reported among 23.1% patients. After adjusting for demographic and clinical factors, the mean reimbursements were statistically significantly higher among patients with reoperations ($48,495 vs $15,921), nonunion ($35,317 vs $20,185) and mechanical complications ($44,949 vs $20,695) as compared to patients without the complications (All P<0.0001).

CONCLUSIONS: A high proportion of patients with osteoporosis or osteopenia (23%) required a second tibial surgery after initial fixation with an IMN. Patients with complications required at least 1.7 times higher reimbursements than those without. Novel tibial nailing systems that would reduce the need for reoperations and lower the risk of complications are warranted in patients with poor bone quality.