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Resume Introduction L’enclouage centromedullaire (ECM) constitue le traitement de reference des fractures diaphysaires du tibia, mais reste potentiellement associe a un taux de complication mecanique, et particulierement de retard de consolidation (RC). Hypothese Nous pensons que les complications ne surviennent pas par hasard, mais sur un terrain propice a leur developpement qu’il faut mettre en evidence. Les facteurs de risque (FR) susceptibles de predire le RC peuvent etre identifies en vue de proposer une approche davantage preventive. Materiel et methodes Une serie de 171 fractures traitees par ECM entre 2005 et 2015 ont ete revues retrospectivement. Les variables independantes incluaient des facteurs intrinseques aux patients et des facteurs extrinseques, dependants de la fracture ou de la chirurgie. Un modele de regression logistique multiple a ete utilise pour determiner les facteurs potentiellement predictifs de chaque complication. Resultats Le retard de consolidation touche 22,8 % des patients. Le tabac et le traumatisme a haute energie en sont les FR. Le risque de bris de materiel diminue significativement (p 10 mm. Un rapport diametre clou diametre alesoir au-dela des limites predites (0,80–0,99) est davantage associe au bris de vis. Le diabete est un FR pour un deplacement du materiel de synthese qui est associee, elle-meme, a d’autres complications. Discussion Le defaut de consolidation represente la complication la plus frequente apres ECM du tibia. L’eviction du tabac dans les suites d’une fracture nous parait necessaire, meme si la litterature reste ambivalente sur ce plan et qu’il n’est pas certain que l’arret a ce stade soit suffisant que pour prevenir une evolution pejorative. L’utilisation d’un rapport diametre clou diametre alesoir entre 0,8 et 0,99 favorise la consolidation et previent le bris du materiel. Le deplacement du materiel chez un patient diabetique doit laisser craindre d’autres complications. Niveau de preuve IV, Etude retrospective.

Despite the progress in tibial fracture care, some patients contract infection following intramedullary nailing. We analyzed which risk factors could predict infection in 171 tibial fractures. The independent variables included age, gender, body mass index, and comorbidities, along with external factors of fracture pattern, nailing settings, and treatment processing time. A multiple logistic regression was used to identify infection risk factors. The risk of infection significantly increased according to the open grading, the fractures' classification, time until antibiotic administration, and time until nailing. Gustilo type I fractures presented a higher rate of infection than expected, explained by a longer delay before surgery. The probabilistic equation allows infection prediction with high sensitivity and specificity. In total, we showed that no antibiotics' prescription in emergency service and a transverse fracture pattern were predictors of infection. An infection risk score can be computed, aiding surgeons in decision making. Outcomes could improve keeping these observations in mind. Level of evidence: Retrospective cohort study. Level iii.

INTRODUCTION: Intramedullary (IM) nailing is the gold standard treatment for tibial shaft fractures, but can be associated with various mechanical complications, including delayed union. HYPOTHESIS: We believe that complications do not occur randomly, but in certain conditions that contribute to their development. Risk factors likely to predict delayed union can be identified to support prevention. MATERIALS AND METHODS: A cohort of 171 fractures treated by IM nailing between 2005 and 2015 was reviewed retrospectively. Independent variables included intrinsic, patient-related factors and extrinsic factors such as those related to the fracture or surgery. A multiple logistic regression model was used to determine which factors can predict each type of complication. RESULTS: Delayed union occurred in 22.8% of patients. Smoking and high-energy trauma were risk factors. Hardware breakage was significantly reduced (p