Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

• Published in: Journal of orthopaedic surgery and research Vol. 15; no. 1; pp. 377 - 16
• Main Authors: Tian, Ruifeng, Zheng, Fang, Zhao, Wei, Zhang, Yuhui, Yuan, Jinping, Zhang, Bowen, Li, Liangman
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.09.2020; BioMed Central; BMC
• Subjects: Adolescent; Adult; Age Factors; Aged; Analysis; Anti-Inflammatory Agents, Non-Steroidal; Bias; Body Mass Index; Care and treatment; Closed Fracture Reduction - methods; Diabetes; Diabetes mellitus; Female; Fracture Fixation, Internal - methods; Fractures; Fractures (Injuries); Fractures, Ununited - epidemiology; Fractures, Ununited - etiology; Fractures, Ununited - surgery; Humans; Infections; Inflammation; Influencing factors; Internal fixation; Male; Medical research; Meta-analysis; Middle Aged; Minimally Invasive Surgical Procedures - methods; Narcotics; Nonsteroidal anti-inflammatory drugs; Nonunion; Online searching; Open fractures; Opioid-Related Disorders; Opioids; Orthopedics; Osteosynthesis; Physicians; Prevalence; Prevalence studies (Epidemiology); Risk Factors; Sex Factors; Smoking; Systematic Review; Tibia; Tibia fracture; Tibial Fractures - epidemiology; Tibial Fractures - etiology; Tibial Fractures - surgery; Tobacco; Tobacco Smoking; Young Adult; Canada; United States > US; China; Systematic review; Nonunion; Prevalence; Influencing factors; Tibia fracture
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-020-01904-2

The aim of this study is to assess the prevalence of nonunion in patients with tibia fracture and the association between influencing factors and tibia fracture nonunion. A database searches of PubMed, the Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Weipu database, and Wanfang database from inception until June 2019 was conducted. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata software. In this study, 111 studies involving 41,429 subjects were included. In the study of the relationship between influencing factors and tibia fracture nonunion, 15 factors significantly influenced the fracture union, including > 60 years old, male, tobacco smoker, body mass index > 40, diabetes, nonsteroidal anti-inflammatory drugs (NSAIDs) user, opioids user, fracture of middle and distal tibia, high-energy fracture, open fracture, Gustilo-Anderson grade IIIB or IIIC, Müller AO Classification of Fractures C, open reduction, fixation model, and infection. The prevalence of nonunion in patients with tibia fracture was 0.068 and 15 potential factors were associated with the prevalence. Closed reduction and minimally invasive percutaneous plate osteosynthesis (MIPPO) have the low risks of nonunion for the treatment of tibial fractures.