Nonunion after primary treatment of tibia fractures with external fixation

The authors retrospectively reviewed 207 fractures of tibial diaphysis, treated primarily with external fixation without bone grafting. Forty-two fractures (20.3%) resulted in nonunion and required reoperation. Parameters analyzed for their significance for nonunion included, soft tissue damage, energy of injury, method of fracture reduction, type of external fixation frame, supplemental interfragmentary screw fixation, dynamization at the fracture site, and postoperative infection. Nonunion rate was found to be significantly higher in type II and III open fractures, high-energy fractures, fractures treated by external fixation using a bilateral frame, and fractures treated with supplemental interfragmentary screw fixation. Multivariate analysis showed that type II and III open fracture, high-energy injury, and supplemental interfragmentary screw fixation were the main risk factors for nonunion.