Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis
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(2020) 15:377
SYSTEMATIC REVIEW
Open Access
Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis Ruifeng Tian1, Fang Zheng1,2, Wei Zhao1,3, Yuhui Zhang4, Jinping Yuan4, Bowen Zhang1 and Liangman Li1*
Abstract Objective: 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. Method: 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. Results: 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. Conclusion: 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. Keywords: Tibia fracture, Nonunion, Prevalence, Influencing factors, Systematic review
Introduction Fracture is a common disease that has a great impact on patients’ lives. Take Canada as an example, fractures and dislocations of the lower limb make up 38% of all injury admissions [1]. It is estimated that the disability from traffic accidents (the major cause of fractures) will rank the top three of all causes of disability by 2020 [2]. Fracture nonunion is one of the most common complications of fracture. The rate of fracture nonunion varies greatly in different anatomical locations of the fracture [3], with an average incidence rate of * Correspondence: [email protected] 1 Department of Orthopaedics, No.1 Hospital of China Medical University, Guangzhou, China Full list of author information is available at the end of the article
4.93% [4]. Fracture nonunion is a chronic condition in terms of pain, and functional and psychosocial disability [5]. Nonunion of some fractures can reduce the quality of life and even increase the risk of death [3]. The cost of treatment for fracture nonunion was much more than that of fracture union [6, 7]. Other economic burdens caused by prolonged disability and downtime of job are more difficult to quantify but must be considered [8]. Good blood supply is an important condition for fracture union [1, 9]. Compared to other long bones with abundant blood vessels and soft tissue,
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