Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures

Tay, Wei-Han; Steiger, Richard N. de; Richardson, Martin; Gruen, Russell L.; Balogh, Zsolt J.

doi:10.1016/j.injury.2014.06.025

Cited by 116 publications

(96 citation statements)

References 48 publications

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“…Some treatments, such as BMP, are used at the time of surgery [4], and some medications may be more effective if administered earlier in the healing process. Earlier identification of those at risk may lead to closer follow-up, faster identification of slow healing, quicker intervention, and therefore decreased social health costs [3]. Our experts agreed with the literature that supports smoking [5,6] and diabetes [7] as risk factors for delayed fracture healing.…”

Section: Goals Of Fracture Healingsupporting

confidence: 69%

“…Delayed fracture healing is common. Up to a third of femoral shaft or tibial fractures may develop delayed union or non-union [3]. Delayed fracture healing leads to considerable morbidity in patients, in particular increased pain and loss of function [3].…”

Section: Goals Of Fracture Healingmentioning

confidence: 99%

“…Up to a third of femoral shaft or tibial fractures may develop delayed union or non-union [3]. Delayed fracture healing leads to considerable morbidity in patients, in particular increased pain and loss of function [3]. This, in turn, can lead to a lower quality of life as well as an increased time prior to return to work, resulting in a negative cost to society.…”

Section: Goals Of Fracture Healingmentioning

confidence: 99%

See 2 more Smart Citations

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

Silverman

Kupperman²,

Bukata³

2016

Osteoporos Int

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Section: Goals Of Fracture Healingsupporting

confidence: 69%

Section: Goals Of Fracture Healingmentioning

confidence: 99%

Section: Goals Of Fracture Healingmentioning

confidence: 99%

See 1 more Smart Citation

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

Silverman

Kupperman²,

Bukata³

2016

Osteoporos Int

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“…Although these materials meet the requirements of clinical application in terms of biocompatibility and mechanical properties, the incidence of fracture-related complications such as infection, delayed union, and nonunion remain a major clinical problem that further increases the suffering and financial burden of fracture patients. [7][8][9][10] Therefore, imparting antibacterial and/ or osteogenic properties to the existing metal implants is crucial for improving the prognosis of fracture and reducing postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Nano-copper-bearing stainless steel promotes fracture healing by accelerating the callus evolution process

Wang¹,

Li²,

Ren³

et al. 2017

IJN

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Treatment for fractures requires internal fixation devices, which are mainly produced from stainless steel or titanium alloy without biological functions. Therefore, we developed a novel nano-copper-bearing stainless steel with nano-sized copper-precipitation (317L-Cu SS). Based on previous studies, this work explores the effect of 317L-Cu SS on fracture healing; that is, proliferation, osteogenic differentiation, osteogenesis-related gene expression, and lysyl oxidase activity of human bone mesenchymal stem cells were detected in vitro. Sprague–Dawley rats were used to build an animal fracture model, and fracture healing and callus evolution were investigated by radiology (X-ray and micro-CT), histology (H&E, Masson, and safranin O/fast green staining), and histomorphometry. Further, the Cu 2+ content and Runx2 level in the callus were determined, and local mechanical test of the fracture was performed to assess the healing quality. Our results revealed that 317L-Cu SS did not affect the proliferation of human bone mesenchymal stem cells, but promoted osteogenic differentiation and the expression of osteogenesis-related genes. In addition, 317L-Cu SS upregulated the lysyl oxidase activity. The X-ray and micro-CT results showed that the callus evolution efficiency and fracture healing speed were superior for 317L-Cu SS. Histological staining displayed large amounts of fibrous tissues at 3 weeks, and cartilage and new bone at 6 weeks. Further, histomorphometric analysis indicated that the callus possessed higher osteogenic efficiency at 6 weeks, and a high Cu 2+ content and increased Runx2 expression were observed in the callus for 317L-Cu SS. Besides, the mechanical strength of the fracture site was much better than that of the control group. Overall, we conclude that 317L-Cu SS possesses the ability to increase Cu 2+ content and promote osteogenesis in the callus, which could accelerate the callus evolution process and bone formation to provide faster and better fracture healing.

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“…6 Determination of the probability for and potential mitigation of nonunion risk is an important clinical objective because patients with nonunion can expect more long-term pain, physical disability, mental health problems, and medical treatment costs as well as a slower return to normal work productivity. 7 Herein, we describe the epidemiology of fracture nonunion in adults, with a focus on information available to the clinician at patient presentation. We hypothesize that the interplay between a patient's physiologic risk factors and fracture characteristics increases the risk of fracture nonunion.…”

mentioning

confidence: 99%

Epidemiology of Fracture Nonunion in 18 Human Bones

et al. 2016

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IMPORTANCE Failure of bone fracture healing occurs in 5% to 10% of all patients. Nonunion risk is associated with the severity of injury and with the surgical treatment technique, yet progression to nonunion is not fully explained by these risk factors.OBJECTIVE To test a hypothesis that fracture characteristics and patient-related risk factors assessable by the clinician at patient presentation can indicate the probability of fracture nonunion.DESIGN, SETTING, AND PARTICIPANTS An inception cohort study in a large payer database of patients with fracture in the United States was conducted using patient-level health claims for medical and drug expenses compiled for approximately 90.1 million patients in calendar year 2011. The final database collated demographic descriptors, treatment procedures as per Current Procedural Terminology codes; comorbidities as per International Classification of Diseases, Ninth Revision codes; and drug prescriptions as per National Drug Code Directory codes. Logistic regression was used to calculate odds ratios (ORs) for variables associated with nonunion. Data analysis was performed from January 1, 2011, to December 31, 2012, EXPOSURES Continuous enrollment in the database was required for 12 months after fracture to allow sufficient time to capture a nonunion diagnosis. RESULTSThe final analysis of 309 330 fractures in 18 bones included 178 952 women (57.9%); mean (SD) age was 44.48 (13.68) years. The nonunion rate was 4.9%. Elevated nonunion risk was associated with severe fracture (eg, open fracture, multiple fractures), high body mass index, smoking, and alcoholism. Women experienced more fractures, but men were more prone to nonunion. The nonunion rate also varied with fracture location: scaphoid, tibia plus fibula, and femur were most likely to be nonunion. The ORs for nonunion fractures were significantly increased for risk factors, including number of fractures (OR, 2.65; 95% CI, 2.34-2.99), use of nonsteroidal anti-inflammatory drugs plus opioids (OR, 1.84; 95% CI, 1.73-1.95), operative treatment (OR, 1.78; 95% CI, 1.69-1.86), open fracture (OR, 1.66; 95% CI, 1.55-1.77), anticoagulant use (OR, 1.58; 95% CI, 1.51-1.66), osteoarthritis with rheumatoid arthritis (OR, 1.58; 95% CI, 1.38-1.82), anticonvulsant use with benzodiazepines (OR, 1.49; 95% CI, 1.36-1.62), opioid use (OR, 1.43; 95% CI, 1.34-1.52), diabetes (OR, 1.40; 95% CI, 1.21-1.61), high-energy injury (OR, 1.38; 95% CI, 1.27-1.49), anticonvulsant use (OR, 1.37; 95% CI, 1.31-1.43), osteoporosis (OR, 1.24; 95% CI, 1.14-1.34), male gender (OR, 1.21; 95% CI, 1.16-1.25), insulin use (OR, 1.21; 95% CI, 1.10-1.31), smoking (OR, 1.20; 95% CI, 1.14-1.26), benzodiazepine use (OR, 1.20; 95% CI, 1.10-1.31), obesity (OR, 1.19; 95% CI, 1.12-1.25), antibiotic use (OR, 1.17; 95% CI, 1.13-1.21), osteoporosis medication use (OR, 1.17; 95% CI, 1.08-1.26), vitamin D deficiency (OR, 1.14; 95% CI, 1.05-1.22), diuretic use (OR, 1.13; 95% CI, 1.07-1.18), and renal insufficiency (OR, 1.11; 95% CI, 1.04-1.17) (multivariate P < .001 for all).C...

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Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures

Abstract: Despite modern treatment, the patient-reported outcomes of lower limb long bone shaft fractures do not return to normal at one year. Patients with delayed union or nonunion can expect poorer outcomes.

Cited by 116 publications

References 48 publications

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

Nano-copper-bearing stainless steel promotes fracture healing by accelerating the callus evolution process

Epidemiology of Fracture Nonunion in 18 Human Bones

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