{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T11:02:53Z","timestamp":1794654173184,"version":"4.9.1"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine factors associated with nonunion of adult tibial fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective review with data collection for logistic regression and survival analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Scottish Level I trauma center, 1985\u20132007.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>During this period, 1590 adult tibial fractures were treated by reamed nailing and 1003 fractures met all inclusion criteria for the chosen analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention:<\/jats:title>\n                    <jats:p>Reamed intramedullary nailing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures:<\/jats:title>\n                    <jats:p>Record of nonunion diagnosis and final union time with characteristics, including age, gender, closed or open injury, OTA\/AO classification, Gustilo classification, fasciotomy, infection, polytrauma, smoking, and injury severity score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The overall nonunion rate was 12%, and median time to healing was 18 weeks. Age significantly influenced nonunion, with middle-aged patients at highest risk. Both fracture type (closed\/open) and morphology (OTA\/AO classification) significantly influenced nonunion risk and time to union. Among closed injuries, the highest nonunion rate was for OTA\/AO type B fractures (15%). Among open injuries, the highest nonunion rate was for OTA\/AO type C (61%). Both compartment syndrome and smoking did not significantly influence nonunion risk but did significantly extend time to union.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Injury characteristics including fracture morphology and severity of soft tissue injury were strong predictors of compromised fracture healing. Age also influenced nonunion risk in an unexpected way, with highest rates in the middle decades of adulthood. Future studies should consider the possibility of similar age-related effects and clinical studies should seek to identify explanations for why this may arise, including both physiological and socio-behavioral factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000001173","type":"journal-article","created":{"date-parts":[[2018,4,17]],"date-time":"2018-04-17T17:09:43Z","timestamp":1523984983000},"page":"e263-e269","source":"Crossref","is-referenced-by-count":82,"title":["Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing: Risk Factors Based on a Single-Center Review of 1003 Patients"],"prefix":"10.1097","volume":"32","author":[{"given":"Hannah L.","family":"Dailey","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Lehigh University, Bethlehem, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Shi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Lehigh University, Bethlehem, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret M.","family":"McQueen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Trauma, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles M.","family":"Court-Brown","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Trauma, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-20230828","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.2106\/JBJS.J.01418","article-title":"Prognostic factors for predicting outcomes after intramedullary nailing of the tibia","volume":"94","author":"Schemitsch","year":"2012","journal-title":"J Bone Jt Surg Am."},{"key":"R3-20230828","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/00005131-200305000-00006","article-title":"Predictors of reoperation following operative management of fractures of the tibial shaft","volume":"17","author":"Bhandari","year":"2003","journal-title":"J Orthop Trauma."},{"key":"R4-20230828","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/00005131-200402000-00007","article-title":"Reamed intramedullary nailing: an overview and analysis of 1106 cases","volume":"18","author":"Court-Brown","year":"2004","journal-title":"J Orthop Trauma."},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.injury.2014.12.018","article-title":"Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients","volume":"46","author":"Metsemakers","year":"2015","journal-title":"Injury."},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1097\/BOT.0000000000000311","article-title":"Dynamizations and exchanges: success rates and indications","volume":"29","author":"Litrenta","year":"2015","journal-title":"J Orthop Trauma."},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2474-14-42","article-title":"Tibia shaft fractures: costly burden of nonunions","volume":"14","author":"Antonova","year":"2013","journal-title":"BMC Musculoskelet Disord."},{"key":"R8-20230828","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1016\/j.injury.2014.06.025","article-title":"Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures","volume":"45","author":"Tay","year":"2014","journal-title":"Injury."},{"key":"R9-20230828","first-page":"256","article-title":"Closed tibial shaft fractures: management and treatment complications. 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