Retrospective cohort study of 382 tibial shaft fractures treated with reamed IM nails, asking whether clinical variables available at the time of fixation can predict which fractures — initially expected to heal — will go on to nonunion. The study deliberately excluded fractures with planned nonunion surgery or 0% cortical contact to surface subtler predictors beyond obvious fracture gap.
When nailing a tibial shaft fracture, calculate the NURD score at the time of fixation: patients scoring >9 face a 42–61% nonunion risk and warrant early discussion of prophylactic bone grafting, closer radiographic surveillance, and realistic counseling — while a score ≤5 (especially with a spiral pattern or low-energy mechanism) is reassuring at only 2% risk.
Retrospective cohort study of 382 tibial shaft fractures treated with reamed IM nails, asking whether clinical variables available at the time of fixation can predict which fractures — initially expected to heal — will go on to nonunion. The study deliberately excluded fractures with planned nonunion surgery or 0% cortical contact to surface subtler predictors beyond obvious fracture gap.
When nailing a tibial shaft fracture, calculate the NURD score at the time of fixation: patients scoring >9 face a 42–61% nonunion risk and warrant early discussion of prophylactic bone grafting, closer radiographic surveillance, and realistic counseling — while a score ≤5 (especially with a spiral pattern or low-energy mechanism) is reassuring at only 2% risk.