Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

Tian, Ruifeng; Zheng, Fang; Zhao, Wei; Zhang, Yuhui; Yuan, Jinping; Zhang, Bowen; Li, Liangman

doi:10.1186/s13018-020-01904-2

Journal of Orthopaedic Surgery and Research

Table 2 The pooled results and subgroup analysis of prevalence of nonunion from tibia fracture patient

From: Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

		Number of study	N	n	Prevalence rate			Heterogeneity		Model
		Number of study	N	n	effect size	lower limit	upper limit	I²	p	Model
Total		111	41429	3817	0.068	0.060	0.077	86.60%	< 0.01	Random
1. Age (year)	< 60	3	545	60	0.125	0.060	0.189	77.50%	0.012	Random
1. Age (year)	> 60	3	316	65	0.204	0.160	0.249	0.00%	0.689	Fixed
2. Gender	Male	11	8186	790	0.131	0.104	0.159	77.80%	< 0.01	Random
2. Gender	Female	11	8123	618	0.118	0.085	0.150	84.50%	< 0.01	Random
3. Tobacco smoker	Yes	8	2263	299	0.173	0.119	0.226	91.80%	< 0.01	Random
3. Tobacco smoker	No	8	12177	888	0.111	0.072	0.150	87.30%	< 0.01	Random
4. Drink	Yes	2	348	42	0.136	0.036	0.235	82.50%	0.017	Random
4. Drink	No	2	12842	958	0.098	0.043	0.152	86.90%	0.006	Random
5. Body mass index	< 30	2	24466	2257	0.091	0.049	0.133	99.30%	< 0.01	Random
	> 30	2	3790	451	0.119	0.109	0.129	0.00%	0.557	Fixed
	30–40	2	2507	236	0.094	0.083	0.105	0.00%	0.441	Fixed
	< 40	2	26973	2493	0.091	0.053	0.128	99.20%	< 0.01	Random
	> 40	2	1283	215	0.160	0.020	0.218	87.80%	0.004	Random
6. Diabetes	Yes	4	347	73	0.221	0.178	0.267	8.50%	0.335	Fixed
	No	4	984	103	0.102	0.065	0.139	67.50%	0.046	Random
	Yes	3	371	58	0.153	0.116	0.189	0.00%	0.420	Fixed
	No	3	1197	144	0.117	0.099	0.135	59.90%	0.083	Random
8. Opioids user	Yes	3	1035	145	0.140	0.118	0.161	0.00%	0.694	Fixed
8. Opioids user	No	3	522	58	0.097	0.031	0.164	78.40%	0.010	Random
9. Fracture site	Proximal	7	586	30	0.043	0.027	0.06	26.50%	0.254	Fixed
	Middle	7	724	115	0.146	0.080	0.211	84.60%	< 0.01	Random
	Distal	7	614	88	0.139	0.104	0.178	24.10%	0.253	Fixed
10. Injury energy	High	4	710	105	0.149	0.083	0.241	83.60%	< 0.01	Random
10. Injury energy	Low	4	298	22	0.065	0.007	0.175	87.30%	< 0.01	Random
11.Open fracture	Yes	10	14037	916	0.062	0.049	0.074	56.20%	0.015	Random
11.Open fracture	On	10	1985	390	0.197	0.145	0.294	84.80%	< 0.01	Random
12. Gustilo-Anderson grade^a	I or II	9	680	57	0.070	0.051	0.089	31.30%	0.168	Fixed
	IIIA	9	394	55	0.130	0.097	0.163	0.00%	0.686	Fixed
	IIIB or IIIC	9	220	89	0.382	0.198	0.566	88.90%	< 0.01	random
13.Müller AO Classification of Fractures (AO) classification^b	A	7	1039	69	0.059	0.027	0.090	68.90%	0.004	Random
	B	7	600	103	0.140	0.086	0.204	65.90%	0.007	Random
	C	7	285	54	0.158	0.078	0.260	74.50%	0.001	Random
14. Debride time	< 6 h	2	138	41	0.302	0.074	0.530	89.10%	0.002	Random
14. Debride time	> 6 h	2	49	20	0.405	0.268	0.541	0.00%	0.411	Fixed
15. Open reduction	Yes	9	573	48	0.075	0.043	0.107	52.40%	0.032	Random
15. Open reduction	No	9	606	26	0.043	0.028	0.060	42.10%	0.086	Fixed
16. Fixation mode^c	ORIF	41	6216	703	0.081	0.058	0.107	82.10%	< 0.01	Random
	IMN	51	12642	1326	0.054	0.040	0.070	77.30%	< 0.01	Random
	MIPPO	25	988	18	0.023	0.015	0.032	0.00%	0.835	Fixed
	External fixation		680	33	0.055	0.023	0.098	76.90%	< 0.01	Random
	Conservative treatment	4	116	22	0.134	0.003	0.409	92.10%	< 0.01	Random
17. Fibula fixed	Yes	7	166	11	0.073	0.027	0.140	53.20%	0.046	Random
17. Fibula fixed	No	7	538	69	0.122	0.094	0.149	< 0.01	0.611	Fixed
18. Osteofascial compartment syndrome	Yes	3	210	31	0.134	0.088	0.179	61.90%	0.072	Fixed
18. Osteofascial compartment syndrome	No	3	1359	162	0.105	0.058	0.151	85.40%	0.001	Random
19. Infection	Yes	2	217	84	0.510	0.155	0.866	93.80%	< 0.01	Random
19. Infection	No	2	1366	119	0.076	0.022	0.129	92.80%	< 0.01	Random

^aGustilo-Anderson classification: grade I: clean wound < 1 cm in length; grade II: wound 1–10 cm in length without extensive soft-tissue damage, flaps or avulsions; grade III: extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture; grade IIIa: adequate periosteal coverage of the fracture bone despite the extensive soft-tissue laceration or damage; grade IIIb: extensive soft-tissue loss, periosteal stripping and bone damage, usually associated with massive contamination; grade IIIc: associated with an arterial injury requiring repair, irrespective of degree of soft-tissue injury
^bAO classification of tibia fractures with designations of A: simple, B: wedge, C: complex
^cORIF open reduction and internal fixation, IMN intramedullary nailing, MIPPO minimally invasive plate osteosynthesis

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