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Introduction <p>Recent orthopaedic trauma literature has linked blood transfusions with poor outcomes due to proposed deleterious effects on healing. The aim of this study was to determine the association of perioperative allogenic blood transfusion after tibial shaft fixation with nonunion and fracture related infection (FRI).</p> Methods <p>A retrospective cohort of patients at two level 1 trauma centers over a 12-year period who sustained extra-articular tibial shaft fractures treated with intermedullary nailing (IMN) or open reduction internal fixation (ORIF). A minimum follow-up of six months was required unless there was presence of clinical and radiographic union prior to six months. Peri-operative allogenic red blood cell transfusion was the primary independent variable. Outcomes included fracture-related infection (FRI) and nonunion. Sub-analyses were completed in patients with open and closed fractures separately.</p> Results <p>550 tibia fractures met inclusion criteria. Mean age was 45&#xa0;years. 333 (61%) patients were male. 247 (45%) patients were current tobacco users. 335 (59%) patients sustained a high energy fracture mechanism. 71 fractures (13%) were classified as AO/OTA 42-C and 230 fractures (42%) were open. Mean follow up was 18.2 ± 17&#xa0;months. 138 patients (25%) received a peri-operative blood transfusion. 54 patients (10%) were diagnosed with FRI and 86 patients (16%) were diagnosed with nonunion. Multivariate regression analysis demonstrated no independent association between transfusion and FRI for the whole cohort (OR 1.6; 95% CI 0.9–2.9; <i>p</i> = 0.1) or in patients with open fracture (N = 230, 19% transfusion versus 14% no transfusion, <i>p</i> = 0.3). Multivariate regression analysis demonstrated no independent association between transfusion and nonunion for the whole cohort (OR 1.8; 95% CI 0.9–3.3; <i>p</i> = 0.1) but did demonstrate an independent association for patients with open fractures (N = 230, OR 2.0; 95% CI 1.1–3.7; <i>p</i> = 0.03).</p> Conclusions <p>This multicenter study demonstrated that nonunion, but not FRI, may be associated with peri-operative red blood cell transfusion in open tibial shaft fractures. Surgeons may consider indications for transfusion after open tibia fracture fixation to minimize risk of poor outcomes.</p> Level of Evidence <p>Level III Prognostic.</p>

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Association between perioperative allogenic blood transfusion and risk of fracture related infection and nonunion in operatively treated tibial shaft fractures

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Jeremy M. Adelstein,
  • Tyler J. Moon,
  • Lucas R. Haase,
  • Victoria J. Nedder,
  • Anna M. Swetz,
  • Logan M. Good,
  • George Ochenjele,
  • Robert J. Wetzel,
  • John K. Sontich,
  • Nicholas M. Romeo,
  • Joshua K. Napora

摘要

Introduction

Recent orthopaedic trauma literature has linked blood transfusions with poor outcomes due to proposed deleterious effects on healing. The aim of this study was to determine the association of perioperative allogenic blood transfusion after tibial shaft fixation with nonunion and fracture related infection (FRI).

Methods

A retrospective cohort of patients at two level 1 trauma centers over a 12-year period who sustained extra-articular tibial shaft fractures treated with intermedullary nailing (IMN) or open reduction internal fixation (ORIF). A minimum follow-up of six months was required unless there was presence of clinical and radiographic union prior to six months. Peri-operative allogenic red blood cell transfusion was the primary independent variable. Outcomes included fracture-related infection (FRI) and nonunion. Sub-analyses were completed in patients with open and closed fractures separately.

Results

550 tibia fractures met inclusion criteria. Mean age was 45 years. 333 (61%) patients were male. 247 (45%) patients were current tobacco users. 335 (59%) patients sustained a high energy fracture mechanism. 71 fractures (13%) were classified as AO/OTA 42-C and 230 fractures (42%) were open. Mean follow up was 18.2 ± 17 months. 138 patients (25%) received a peri-operative blood transfusion. 54 patients (10%) were diagnosed with FRI and 86 patients (16%) were diagnosed with nonunion. Multivariate regression analysis demonstrated no independent association between transfusion and FRI for the whole cohort (OR 1.6; 95% CI 0.9–2.9; p = 0.1) or in patients with open fracture (N = 230, 19% transfusion versus 14% no transfusion, p = 0.3). Multivariate regression analysis demonstrated no independent association between transfusion and nonunion for the whole cohort (OR 1.8; 95% CI 0.9–3.3; p = 0.1) but did demonstrate an independent association for patients with open fractures (N = 230, OR 2.0; 95% CI 1.1–3.7; p = 0.03).

Conclusions

This multicenter study demonstrated that nonunion, but not FRI, may be associated with peri-operative red blood cell transfusion in open tibial shaft fractures. Surgeons may consider indications for transfusion after open tibia fracture fixation to minimize risk of poor outcomes.

Level of Evidence

Level III Prognostic.