{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T05:38:34Z","timestamp":1738042714306,"version":"3.33.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","funder":[{"DOI":"10.13039\/100001473","name":"AO North America","doi-asserted-by":"crossref","award":["171408-FEL2021"],"award-info":[{"award-number":["171408-FEL2021"]}],"id":[{"id":"10.13039\/100001473","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"crossref","award":["K24AR076445"],"award-info":[{"award-number":["K24AR076445"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>This study aimed to assess the relationship between postoperative alignment and nonunion in patients with tibial shaft fractures treated with intramedullary nailing.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective case\u2013control study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Single academic trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients Selection Criteria:<\/jats:title>\n            <jats:p>Adult patients with closed or open tibial shaft fractures (42A-C) treated with intramedullary nailing from 2007 to 2018.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcomes Measures and Comparisons:<\/jats:title>\n            <jats:p>Case patients with nonunion were compared with control patients with radiographic evidence of healing in terms of the postoperative tibial alignment measured in the coronal and sagittal planes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Of the 192 included patients (median age, 38 years; 76% male), 51 patients had a nonunion, and 141 patients had united fractures and served as the control group. A strong association between postoperative tibial malalignment in 1 plane and nonunion (odds ratio, 3.0; 95% confidence interval, 1.1\u20138.3; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.03) was demonstrated. This association was even greater for malalignment in both coronal and sagittal planes (odds ratio, 5.7; 95% confidence interval, 2.1\u201316.1; <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001) after controlling for confounders.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>After controlling for confounding factors, postoperative malalignment in the coronal or sagittal plane was associated with significantly increased odds of tibial shaft nonunion after intramedullary nailing.<\/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.0000000000002932","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T14:00:36Z","timestamp":1731420036000},"page":"57-62","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Tibial Malalignment Is an Independent Predictor of Nonunion After Intramedullary Nailing of Tibial Shaft Fractures"],"prefix":"10.1097","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2168-2907","authenticated-orcid":false,"given":"Abraham","family":"Goch","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2871-6396","authenticated-orcid":false,"given":"Kathleen","family":"Healey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3046-5437","authenticated-orcid":false,"given":"Nicolas","family":"Zingas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Raffetto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9392-8064","authenticated-orcid":false,"given":"Natasha","family":"McKibben","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5123-5385","authenticated-orcid":false,"given":"Caroline","family":"Benzel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Stockton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0537-3474","authenticated-orcid":false,"given":"Nathan N.","family":"O'Hara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-9239","authenticated-orcid":false,"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-3634","authenticated-orcid":false,"given":"Jason W.","family":"Nascone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert V.","family":"O'Toole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R2-20250127","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/BOT.0b013e318180e646","article-title":"Long-term follow-up of tibial shaft fractures treated with intramedullary nailing","volume":"22","author":"Lefaivre","year":"2008","journal-title":"J Orthop Trauma"},{"key":"R3-20250127","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.injury.2010.02.020","article-title":"Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures","volume":"41","author":"Lam","year":"2010","journal-title":"Injury"},{"key":"R4-20250127","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/00005131-199509060-00004","article-title":"Complications of nailing in closed tibial fractures","volume":"9","author":"Williams","year":"1995","journal-title":"J Orthop Trauma"},{"key":"R5-20250127","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s10195-016-0429-4","article-title":"A prospective multi-center study of intramedullary nailing vs casting of stable tibial shaft fractures","volume":"18","author":"Obremskey","year":"2017","journal-title":"J Orthop Traumatol"},{"key":"R6-20250127","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005131-200003000-00007","article-title":"A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft","volume":"14","author":"Finkemeier","year":"2000","journal-title":"J Orthop Trauma"},{"key":"R7-20250127","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1016\/j.injury.2021.02.040","article-title":"Do Poller screws effect union in tibial shaft fractures treated with intramedullary nailing","volume":"52","author":"Peat","year":"2021","journal-title":"Injury"},{"key":"R8-20250127","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s11999-016-4821-4","article-title":"Will my tibial fracture heal? 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