Risk Factors for Tibial Plafond Nonunion: Medial Column Fixation May Reduce Nonunion Rates.

OBJECTIVES

To identify the incidence and risk factors for development of tibial plafond nonunion.

DESIGN

Retrospective comparative study.

SETTING

Two Level 1 academic trauma centers.

PATIENTS/

PARTICIPANTS

Seven hundred forty tibial plafond fractures (OTA/AO 43B3 and 43C) treated January 2006 to December 2015.

INTERVENTION: Open reduction and internal fixation.

MAIN OUTCOME MEASUREMENT: Nonunion.

RESULTS

Five hundred eighteen patients with a mean age of 43 years (range, 18-81 years) and mean follow-up of 27 months (range, 12-115 months) were involved. Seventy-two patients (72/518, 14%) were identified as having a nonunion. Surgical approach was not associated with nonunion in univariate analysis. Multiple regression model 1 identified OTA/AO 43C [odds ratio (OR) = 4.43; 95% confidence interval (CI), 1.01-19.41; P = 0.048], tobacco use (OR = 2.02; 95% CI, 1.10-3.71; P = 0.024), both minimal and substantial bone loss (P = 0.006 and P < 0.001, respectively), and open fracture (OR = 1.96; 95% CI, 1.10-3.48; P = 0.022) as risk factors for tibial plafond nonunion. Model 2 identified locking plate (OR = 1.97; 95% CI, 1.13-3.40; P = 0.016) and failure to treat the medial column (vs. screw P = 0.047, or plate P = 0.038) as risk factors.

CONCLUSIONS

The tibial plafond nonunion rate was 14%. Bone loss, open fracture, failure to treat the medial column, locking plates, and tobacco use were all significant risk factors for developing tibial plafond nonunion. Equally important, surgical approach was not significantly associated with plafond nonunion.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.