Abstract
Purpose
There is no clear definition of a critical sized defect of the tibia. We defined it as a fracture gap at least one centimeter in length and involving over 50% of the cortical diameter. We explored if the presence of a critical-sized defect predicted reoperation, and which other factors predict reoperation in patients with the critical defect. The patient based outcomes of these patients were compared to patients without a critical defect.
Method
Patients enrolled in the SPRINT trial with a critical sized defect were evaluated for secondary interventions to gain union. Other factors predicting the need for reoperation were studied. We also compared the patients with critical sized defects to the larger cohort of patients without a defect with respect to demographics, injury mechanism, fracture characteristics, and patient-based outcome.
Results
Tibial diaphyseal defects of greater than or equal to one centimeter and >50% cortical circumference healed without additional surgery in 47% of cases. Fewer reoperations were required in patients treated with a reamed nail (p=0.04). The mean of the SF-36 physical component summary in patients with a critical sized defect was poorer than the overall cohort (p=0.02, difference = 5.2, 95% confidence interval 0.8 to 9.6).
Conclusion
This definition of a critical sized defect is not critical in terms of predicting reoperation, as 47% of cases healed without additional intervention. However, patients with these bone defects had a higher rate of reoperation and worse patient based outcomes compared to the overall cohort of tibial fracture patients. Further investigation is recommended.
