Predictors of Delayed Union Following Locking Compression Plate Fixation of Tibial Shaft Fractures: A Prospective...

Delayed union remains a significant challenge following locking compression plate (LCP) fixation of tibial shaft fractures, resulting in prolonged recovery and increased healthcare burden. The present study aimed to evaluate the clinical, biochemical, and radiological factors associated with delayed union following LCP fixation of tibial shaft fractures.

This prospective observational study included 125 adult patients with tibial shaft fractures managed with LCP fixation at a tertiary care teaching hospital. Clinical, biochemical, and radiological parameters were prospectively recorded and compared between patients with normal union (n = 100) and delayed union (n = 25). Variables demonstrating a P < 0.10 on univariate analysis were entered into a multivariable binary logistic regression model to identify independent predictors of delayed union.

Delayed union occurred in 25 (20.0%) patients. Compared with the normal union group, patients with delayed union demonstrated significantly longer times to radiological union (27.6 ± 5.3 vs. 22.1 ± 4.1 weeks; P < 0.001) and unrestricted weight-bearing (23.8 ± 4.7 vs. 18.9 ± 3.6 weeks; P < 0.001). Non-union (16.0% vs. 1.0%; P = 0.005) and reoperation (20.0% vs. 3.0%; P = 0.008) were also significantly more frequent among patients with delayed union. Although several variables, including body mass index, smoking status, serum albumin, vitamin D levels, fracture gap, and radiographic union score for tibial score, demonstrated trends toward association on univariate analysis, none remained an independent predictor after multivariable adjustment.

Delayed union following LCP fixation was associated with inferior clinical outcomes but was not independently predicted by any individual clinical, biochemical, or radiological variable in this cohort, highlighting the multifactorial nature of fracture healing.