Background and purposeFracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population.MethodsNational data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period.Results and interpretationThe overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but—less expectedly—it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.

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The estimated sensitivity and specificity of continuous intracompartmental pressure monitoring for the diagnosis of acute compartment syndrome following tibial diaphyseal fracture are high; continuous intracompartmental pressure monitoring should be considered for patients at risk for acute compartment syndrome.

BACKGROUND:The current available literature related to scaphoid fracture epidemiology is inconsistent. The aim of this study was to describe the epidemiology of true scaphoid fractures in a defined adult population. METHODS:Using a prospective database, we identified all patients who sustained a radiographically confirmed acute fracture of the scaphoid over a 1-year period. Age, gender, mechanism of injury, the Herbert fracture classification, and associated injuries were recorded and analyzed. RESULTS:There were 151 scaphoid fractures diagnosed giving an annual incidence of 29 per 100,000 (95% confidence interval, 25-34). The median age of males was significantly younger when compared with females (p ϭ 0.002), with a male (n ϭ 105) predominance seen (p Ͻ 0.001). Low-energy falls from a standing height were most common (40.4%), but with males being significantly more likely to sustain their fracture after a high-energy injury (p Ͻ 0.001). The most common fracture was Herbert classification B2 (n ϭ 55, 36.4%), with unstable fractures more common in younger patients (p ϭ 0.025) following a high-energy injury (p ϭ 0.042). CONCLUSIONS: We have reported the epidemiology of true scaphoid fractures, with young males at risk of sustaining a fracture. Knowledge of the true incidence of scaphoid fractures and an understanding of the demographic risk factors are essential when assessing the suspected scaphoid fracture, particularly when considering further imaging modalities. (J Trauma. 2012;72: E41-E45. CopyrightA cute scaphoid fractures account for only 2% to 3% of all fractures and ϳ10% of all hand fractures. 1-3 The literature related to the epidemiology of scaphoid fractures is inconsistent with a hundred-fold difference quoted with regards the incidence. 2-8 This is potentially due to the retrospective nature of most analyses, the difficulty associated with defining the population assessed, and the limitation of many databases in distinguishing between suspected and confirmed fractures. 2-8 A clear understanding of the incidence, and the demographic risk factors, associated with a true scaphoid fracture is essential when considering the assessment of the suspected fracture.The aim of this study was to report the epidemiology and demographic risk factors associated with a true acute scaphoid fracture in a large defined population. PATIENTS AND METHODSOur trauma unit serves a captive adult (Ն13 years of age) population of ϳ514,479, with 244,112 males (47.4%) and 270,367 females (52.6%). All inpatient and outpatient fractures that presented acutely to our unit over a 1-year period from July 2007 to June 2008 were recorded prospectively. Patients who presented to our unit but who lived out with our local catchment area were excluded. The regional pediatric hospital manages patients aged less than 13 years and therefore these fractures were not included.A search of our prospective trauma database identified a subgroup of patients who had suffered an acute fracture of the scaphoid. Demographic data were collected for each p...