Rationale and Objectives
Blood supply is vital for sound callus formation. The tibial nutrient artery (TNA)
is the main diaphyseal artery nurturing the tibial shaft. The objective is to investigate
the impact of TNA canal (TNAC) injury on the development of atrophic, oligotrophic,
and hypertrophic nonunion in patients with tibial shaft fractures.
Materials and Methods
Between January 2010 and December 2020, patients with a nonunion of a tibial shaft
fracture were retrospectively included. Two readers independently evaluated the integrity
of the TNAC and classified nonunion type. A multinomial regression model was utilized
to evaluate if a TNAC injury has an impact on the type of nonunion.
Results
From an initial set of 385 patients with the diagnosis of a nonunion of the lower
leg, a total of 60 patients could be finally included in the study. Most patients
were males (78%), diabetic (95%), smokers (73%), and had an American Society of Anesthesiologists
(ASA) score of 2 (72%). TNAC injury was noted in 24 patients (40%): an iatrogenic
TNAC injury was observed in 13 (22%) patients, a traumatic TNAC injury in 11 (18%)
patients. Most patients had a hypertrophic nonunion (29 patients (48%)), followed
by an oligotrophic nonunion (24 patients (40%)) and lastly an atrophic nonunion (seven
patients (11%)). The multinomial regression model showed that there was no impact
of TNAC injury on the development of a specific type of non-union (p = 0.798 for oligotrophic vs. atrophic nonunion; p = 0.943 for hypertrophic vs. atrophic nonunion). Furthermore, patients were about
four times more likely to develop an oligotrophic/hypertrophic nonunion rather than
atrophic one (odds ratio 3.75 and 4.25, respectively), regardless of the presence
of a TNAC injury.
Conclusion
In the evaluated patient cohort with tibial shaft fractures, we could not find a statistically
significant association between TNAC injury and type of nonunion. However, patients
were almost four times more likely to develop oligotrophic or hypertrophic nonunion
rather than an atrophic one although common risk factors for impaired (micro)vascular
blood supply were highly prevalent in the study group. Multicenter studies with a
larger number of atrophic nonunions are warranted to further evaluate this result.
Key Words
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Article info
Publication history
Published online: March 14, 2023
Accepted:
January 31,
2023
Received in revised form:
January 23,
2023
Received:
December 30,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
