# Demographic Differences in the Surgical Management of Tibial Shaft Fractures: A Retrospective Study

## TL;DR

This study examines how tibial shaft fractures are surgically treated in the U.S., finding demographic differences in treatment methods and nonunion rates.

## Contribution

The study provides new insights into demographic patterns and nonunion rates associated with different surgical treatments for tibial shaft fractures.

## Key findings

- ORIF was more common than IMN, with 65% of patients undergoing ORIF compared to 35% with IMN.
- IMN had lower nonunion rates (2.6%) compared to ORIF (4.6%).
- White and non-Hispanic/Latino patients had higher rates of both IMN and ORIF despite higher complication rates in minority groups.

## Abstract

Background

Tibial shaft fractures (TSFs) are the most common long bone fractures in the United States and are associated with significant morbidity and the potential need for revision surgeries, with many patients requiring reoperation. This can have significant physical, mental, and financial impacts on patients. A major complication faced by patients with TSF is nonunion (TSFN). The mainstay of surgical management of TSF is Intramedullary Nail (IMN), with some patients also being treated with Open Reduction Internal Fixation (ORIF). With the demographic makeup of the United States undergoing rapid change, a better understanding of patient characteristics of patients with TSF is useful to optimize patient care. This study aims to enhance our comprehension of the frequency and demographic variables associated with tibia fracture surgery and subsequent nonunion.

Methods

A retrospective study was conducted in August 2023, utilizing the TriNetX “Global Collaborative Network” database to form patient study cohorts. Data extracted included patient age, sex, ethnicity, race, smoking status, surgical management, and nonunion. Data was also extracted on specific surgical management utilized, comprising either IMN or ORIF.

Results

A total of 6,389 cases of TSFs were analyzed, with 65% (4,153) of patients undergoing ORIF compared to IMN (35%, or 2,236). The overall incidence of patients with TSF ORIF and IMN was highest among males and White patients. The incidence of patients with TSF ORIF was highest in the age groups of 40-64 and 64-90 years, while TSF IMN was highest in the age groups of 18-39 and 40-64 years. The overall rate of tibia nonunion among patients with a TSF ORIF was 4.6%, vs. 2.6% in patients who underwent IMN.

Conclusion

TSFs treated with IMN were found to have lower rates of nonunion compared to ORIF. IMN of TSF was more common in younger patients, while ORIF was more common in the older age groups. ORIF and IMN had similar rates of male-to-female utilization, indicating that both genders are being treated similarly with regard to the operative method of choice. White patients and those who were not Hispanic or Latino had much higher rates of both IMN and ORIF compared to all other racial groups, despite the increased complexity of fracture/injury characteristics and higher complication rates in minority patients.