Preoperative malnutrition is associated with increased early complications and higher two-year nonunion risk after Tibial shaft fracture fixation
Recommended Citation
Saad J, Abdelnour D, Boutany M, Elnaggar A, Elmenini H, Almaat A, Mehaidli A, and Vaidya R. Preoperative malnutrition is associated with increased early complications and higher two-year nonunion risk after Tibial shaft fracture fixation. Injury 2026;57(3):113084.
Document Type
Article
Publication Date
3-1-2026
Publication Title
Injury
Keywords
Humans, Tibial Fractures, Male, Female, Malnutrition, Middle Aged, Fracture Healing, Risk Factors, Fractures, Ununited, Postoperative Complications, Adult, Retrospective Studies, Aged, Propensity Score, Fracture Fixation, Internal
Abstract
BACKGROUND: Malnutrition is a potentially modifiable risk factor that may influence perioperative complications and fracture healing. This study evaluated the association between preoperative laboratory-defined malnutrition and short-term complications and 2-year outcomes following operative fixation of tibial shaft fractures.
METHODS: Using the TriNetX Research Network (112 healthcare organizations), adults (≥18 years) undergoing operative management for tibial shaft fracture were identified. Preoperative malnutrition was defined as albumin ≤3.5 g/dL and/or leukocytes ≤1.5 × 10³/µL within 1 year prior to the index event. Cohorts were propensity score matched 1:1 on demographics and comorbidities. Outcomes were assessed from day 1 post-index through 90 days (medical/surgical complications) and 730 days (healing-related and limb outcomes). Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were reported.
RESULTS: After matching, 44,780 patients were included in each cohort (89,560 total), with good balance across covariates (all SMDs < 0.10). At 90 days, malnutrition was associated with higher risk of acute respiratory failure/mechanical ventilation (13.9% vs 3.4%; RR 4.10 [95% CI 3.88-4.33].; HR 4.32 [4.09-4.57].), sepsis (5.2% vs 1.2%; RR 4.35 [3.97-4.77].; HR 4.47 [4.07-4.91].), postoperative infection (5.7% vs 1.8%; RR 3.14 [2.90-3.39].; HR 3.23 [2.99-3.50].), acute kidney injury (8.6% vs 3.0%; RR 2.90 [2.73-3.08].; HR 2.99 [2.81-3.18].), and DVT/PE (6.5% vs 2.7%; RR 2.36 [2.21-2.52].; HR 2.42 [2.26-2.59].) (all p < 0.001). At 2 years, malnutrition was associated with increased nonunion (4.4% vs 1.6%; RR 2.69 [2.47-2.92].; HR 2.85 [2.62-3.10].), chronic osteomyelitis (12.5% vs 3.9%; RR 3.19 [3.02-3.36].; HR 3.50 [3.32-3.69].), hardware removal (10.1% vs 6.0%; RR 1.68 [1.61-1.76].; HR 1.83 [1.74-1.92].), and amputation (1.4% vs 0.4%; RR 3.47 [2.95-4.08].; HR 3.59 [3.05-4.23].) (all p < 0.001). Revision fixation did not differ (8.4% vs 8.1%; p = 0.096).
CONCLUSIONS: Preoperative laboratory-defined malnutrition was independently associated with substantially higher 90-day morbidity and increased 2-year nonunion and limb-complication risk following operative tibial shaft fracture management. These findings support preoperative nutritional risk stratification and targeted optimization efforts in this population.
Medical Subject Headings
Humans; Tibial Fractures; Male; Female; Malnutrition; Middle Aged; Fracture Healing; Risk Factors; Fractures, Ununited; Postoperative Complications; Adult; Retrospective Studies; Aged; Propensity Score; Fracture Fixation, Internal
PubMed ID
41633029
Volume
57
Issue
3
First Page
113084
Last Page
113084
