Nicoll evaluated 705 patients with a fracture of the tibial shaft and characterized the fracture by factors affecting delayed or non-union. This can help identify patients who may require more aggressive management. The author is from Mansfield, England.
Parameters affecting the rate of delayed or non-union:
(1) initial displacement
(2) comminution
(3) wound and soft tissue damage
(4) infection
Infection was the most important but least common factor affecting fracture healing. When present the rate of delayed or no-union was up to 60%.
He analyzed the 652 patients without infection using the following scheme. The analysis was done using Hollerith cards (back when men were men).
|
Finding for Each Parameter |
Significant? |
|
none |
No |
|
slight |
No |
|
moderate |
Yes |
|
severe |
Yes |
|
Displacement |
Comminution |
Wound |
Fracture Type |
|
N |
N |
N |
1 |
|
N |
N |
Y |
2 |
|
N |
Y |
N |
3 |
|
N |
Y |
Y |
5 |
|
Y |
N |
N |
4 |
|
Y |
N |
Y |
6 |
|
Y |
Y |
N |
7 |
|
Y |
Y |
Y |
8 |
He referred to the type as the reflecting the "personality" of the fracture. Personality refers to those features in a fracture that may prevent proper union of the fracture.
|
Fracture Type |
Percent Delayed Union or Non-Union |
|
1 |
9% |
|
2 |
12% |
|
3 |
15% |
|
5 |
39% |
|
4 |
27% |
|
6 |
55% |
|
7 |
31% |
|
8 |
39% |
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
