Factors associated with decline in ambulatory ability following intramedullary nailing of 42A-C diaphyseal tibia fractures

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-07-04 DOI:10.1016/j.jcot.2025.103117

Alexander M. Lashgari , Garret Esper , Abhishek Ganta , Kenneth A. Egol , Sanjit Konda

{"title":"Factors associated with decline in ambulatory ability following intramedullary nailing of 42A-C diaphyseal tibia fractures","authors":"Alexander M. Lashgari , Garret Esper , Abhishek Ganta , Kenneth A. Egol , Sanjit Konda","doi":"10.1016/j.jcot.2025.103117","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to examine factors that were associated with a decline in functional ambulatory status following fractures of the tibial diaphysis.</div></div><div><h3>Methods</h3><div>A retrospective review of an IRB-approved tibial diaphysis fracture database from 2012 to 2024 was conducted. Inclusion criteria were age ≥18, isolated OTA 42A-C tibia fracture treated with an intramedullary nail, and minimum 12 months follow-up. Demographics, injury, and surgical information were collected. Functional ambulatory status was measured at routine follow up intervals by the Functional Ambulatory Category (FAC) score, a six-point scale where zero represents non-ambulation and five represents normal ambulatory ability. Univariate analysis was performed using Student's T-tests and Chi-squared tests. A backwards stepwise multivariate logistic regression analysis was performed to determine factors that were independently associated with a decline in FAC score (SPSS version 29, Armonk, NY).</div></div><div><h3>Results</h3><div>289 patients, with a mean follow up time of 15.04 ± 6.18 months, were included in the analysis with a mean age of 43.24 ± 16.22 years, body mass index of 27.19 ± 6.30, and age-unadjusted Charlson Comorbidity Index of 0.18 ± 0.54. 39.1 % of patients were female, 28.0 % patients sustained open fractures, and 52.6 % sustained high energy injuries. The logistic regression demonstrated that older age (OR = 1.04 p < .001), higher BMI (OR = 1.06 p = .024), high-energy mechanism (OR = 3.18 p = .003), nonunion (OR = 3.66, p = .005), and concomitant lower extremity fractures (OR = 4.47 p = 002), were risk factors for a decrease in final FAC score. The AUROC of the logistic regression equation was 0.787 indicating a moderate ability to discriminate between patients that will experience a loss in functional ambulatory ability and those who will not.</div></div><div><h3>Conclusion</h3><div>This study suggests that concomitant lower extremity injuries, increased age, increased BMI, high-energy mechanisms, and nonunion are risk factors that are associated with a decline in ambulatory capacity following diaphyseal tibia fractures.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103117"},"PeriodicalIF":0.0000,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Orthopaedics and Trauma","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0976566225002152","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The purpose of this study was to examine factors that were associated with a decline in functional ambulatory status following fractures of the tibial diaphysis.

Methods

A retrospective review of an IRB-approved tibial diaphysis fracture database from 2012 to 2024 was conducted. Inclusion criteria were age ≥18, isolated OTA 42A-C tibia fracture treated with an intramedullary nail, and minimum 12 months follow-up. Demographics, injury, and surgical information were collected. Functional ambulatory status was measured at routine follow up intervals by the Functional Ambulatory Category (FAC) score, a six-point scale where zero represents non-ambulation and five represents normal ambulatory ability. Univariate analysis was performed using Student's T-tests and Chi-squared tests. A backwards stepwise multivariate logistic regression analysis was performed to determine factors that were independently associated with a decline in FAC score (SPSS version 29, Armonk, NY).

Results

289 patients, with a mean follow up time of 15.04 ± 6.18 months, were included in the analysis with a mean age of 43.24 ± 16.22 years, body mass index of 27.19 ± 6.30, and age-unadjusted Charlson Comorbidity Index of 0.18 ± 0.54. 39.1 % of patients were female, 28.0 % patients sustained open fractures, and 52.6 % sustained high energy injuries. The logistic regression demonstrated that older age (OR = 1.04 p < .001), higher BMI (OR = 1.06 p = .024), high-energy mechanism (OR = 3.18 p = .003), nonunion (OR = 3.66, p = .005), and concomitant lower extremity fractures (OR = 4.47 p = 002), were risk factors for a decrease in final FAC score. The AUROC of the logistic regression equation was 0.787 indicating a moderate ability to discriminate between patients that will experience a loss in functional ambulatory ability and those who will not.

Conclusion

This study suggests that concomitant lower extremity injuries, increased age, increased BMI, high-energy mechanisms, and nonunion are risk factors that are associated with a decline in ambulatory capacity following diaphyseal tibia fractures.

Abstract Image

查看原文本刊更多论文

42A-C型胫骨骨干骨折髓内钉治疗后活动能力下降的相关因素

背景：本研究的目的是研究与胫骨骨干骨折后功能活动能力下降相关的因素。方法回顾性分析2012 - 2024年经irb批准的胫骨骨干骨折数据库。纳入标准为年龄≥18岁，行髓内钉治疗的孤立性OTA 42A-C胫骨骨折，至少随访12个月。收集了人口统计、损伤和手术信息。在常规随访间隔内，通过功能活动分类（FAC）评分测量功能活动状态，该评分为6分制，0分代表不能活动，5分代表正常活动能力。采用学生t检验和卡方检验进行单因素分析。进行反向逐步多变量logistic回归分析，以确定与FAC评分下降独立相关的因素（SPSS version 29, Armonk， NY）。结果289例患者纳入分析，平均随访时间15.04±6.18个月，平均年龄43.24±16.22岁，体重指数27.19±6.30，年龄未调整Charlson合并症指数0.18±0.54。女性占39.1%，开放性骨折占28.0%，高能损伤占52.6%。logistic回归分析表明，年龄越大(OR = 1.04 p <；.001)、较高的BMI （OR = 1.06 p = 0.024）、高能量机制（OR = 3.18 p = 0.003）、骨不连（OR = 3.66, p = 0.005）和合并下肢骨折（OR = 4.47 p = 002）是最终FAC评分下降的危险因素。logistic回归方程的AUROC为0.787，表明有中等能力区分将经历功能性活动能力丧失的患者和不会经历功能性活动能力丧失的患者。结论：该研究表明，伴随下肢损伤、年龄增长、BMI升高、高能量机制和骨不连是胫骨骨干骨折后活动能力下降的危险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.