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Case: Male 45 Heavy Smoker, Suspected Poly-Substance Abuse Closed Tibial Fracture

Case Information: Male, age 45, heavy smoker, alcoholic, unemployed with suspected poly-substance abuse. Bike accident resulted in a closed tibial fracture, OTA/AO 42-A1.

The RUST score at 12 weeks was 12. On the 12-week CT scan, the callus was clearly bridged and the limb had achieved a virtual torsional rigidity score of VTR = 95% (fractured/intact), which indicates that healing had progressed to near equivalence with the structural rigidity of the intact limb.

Clinical union occurred by 12 weeks, at which point the patient had full functional recovery and reported good health.  Heavy smoking has been frequently reported as a statistically significant risk factor for delayed union and nonunion.

Substance abuse including opioid exposure prior to injury is also associated with a significant increase in nonunion risk.  Given the fracture healing risks in this patient the fact that clinical union was achieved at 12 weeks is an excellent healing result.