The Aseptic Femoral and Tibial Shaft Non-Union in Healthy Patients – An Analysis of the Health-Related Quality of Life and the Socioeconomic Outcome

Abstract

Long bone non-unions may lead to recurrent surgical procedures and in-hospital stays. Thus, restrictions of the health-related quality of life and of socioeconomic parameters might be expected. Knowledge of the impact on several parameters of professional life is sparse. Therefore, we analyzed the outcome in patients following non-unions of the tibial and femoral shaft after fracture compared to patients with uneventful healing.Material and Methodology:51 patients following non-unions of the the femoral (FNU) or tibial shaft (TNU) were compared to 51 patients (groups FH and TH) with uneventful fracture healing. Physical and mental health was assessed using the Short-Form Health Survey (SF-12), Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). We also analyzed employment status and the usage of medical aids.Results:Scores of the SF-12 physical and psychological were lower in group TNU compared to group TH, the score of SF-12 physical but not psychological was significantly lower in group FNU compared to FH. Compared to uneventful healing, a significantly more frequent usage of medical aids was found in both non-union groups. A higher incidence of early retirement and unemployment was found in group FNU but not in group TNU.Conclusions:There is a profound influence on the quality of life following femoral or tibial non-unions after trauma. Compared to patients with uneventful fracture healing, patients with tibial and even more so femoral non-union show worse scores of the SF-12. Medical aids are frequently used following both, femoral and tibial non-unions. Not tibial, but femoral non-unions frequently lead to severe restrictions in professional life such as early retirement and unemployment.

Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow‐derived mesenchymal stromal cells

“…Twelve months after cell implantation in our study, the EQ‐5D index had improved significantly by 0.34 points, suggesting substantial overall improvement for this patient group. Despite this improvement, the EQ‐5D index remained relatively low, in line with a previous study of patients with fracture nonunions . This finding highlights the substantial influence of quality of life from a nonunion fracture.…”

“…Despite this improvement, the EQ-5D index remained relatively low, in line with a previous study of patients with fracture nonunions. 22 This finding highlights the substantial influence of quality of life from a nonunion fracture. The study is limited by being a report of a case series and lacks the robustness of randomization and evaluation of the outcome in a control group; in addition there was great variability in the patient group in terms of previous procedures, time since fracture etc.…”

Treatment of atrophic femoral non-unions according to the diamond concept: Results of one- and two-step surgical procedure

“…44 Zeckey et al compared the outcomes of tibial and femoral non-unions and reached the conclusion that the psychological outcome was comparable in both groups, but that the femoral non-union patients were physically restricted to a greater extent. 4 These findings were confirmed by our own in-house study of the outcome of tibial nonunion treatment, where the readings were MCS 50.9 AE 10.7 and PCS 37.5 AE 8.9. 14 …”

“…Mental conditions such as depression may also occur as a consequence of the posttraumatic psychological distress. 4,5 The treatment of non-union is complex and expensive, placing a burden on the public health system. The costs resulting from the patient's inability to work are relevant to the public economy.…”

Clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments: a retrospective analysis of risk factors for delayed union

“…Much has been reported regarding its favorable bony union rate and lower complication rates 1–7. However, delayed union or non-union after IMN occasionally occurs 8–12. These complications severely affect the activities of daily living and cause socioeconomic problems.…”