Complications following intramedullary nailing (IMN) of tibial shaft fractures are well described in the scientific literature and are feared by surgeons. While risk factors for such complications have not been clearly identified, they could help practitioners to be more vigilant. Surgeons could actually adapt their therapies in patients at risk and thus prevent these harmful consequences for patient and society. In this context, the challenge is to answer a central question: “Is it possible to predict IMN complications after tibial shaft fractures and move towards a preventive approach?”.
MATERIAL AND METHODS
This single center study, conducted at the Cliniques universitaires Saint-Luc, reviewed 171 tibial shaft fractures that occurred between 2005 and 2015. The independent variables included patient-dependent factors (age, comorbidities, etc.) and fracture/ surgery-dependent factors (fracture pattern, IMN features, timing, etc.). A univariate analysis was primarily performed, followed by a multiple logistic regression model in order to determine predictors for each complication.
Open fractures, AO grade, delayed antibiotic prophylaxis (AB), and time to nailing were associated with a significant increase in infections (p<0.05). The nail diameter/reamer diameter ratio was associated with the most material damages. The factors that were correlated to an increased risk of delayed union included tobacco smoking and high-energy trauma. Diabetic patients suffered from more material displacements. A sensible and specific infection risk score (IRS) was developed in order to predict highrisk patients before performing surgery.
In addition to current knowledge, this study showed that the AB delay is a true predictor of infection. Using a nail with a larger diameter or a nail diameter/reamer diameter ratio in the appropriate range appears useful to prevent material failure. These results confirm those found in the only study performed on this subject in 2016. Keeping these observations in mind could be a way of improving outcomes, but we even went further. Our IRS was integrated into an easy-to-use computer software in order to detect infection risk patients and adapt treatment accordingly. The development of this tool could pave the way for a possible reimbursement of preventive treatments (antibiotic-coated nail, etc.).