The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

Abstract

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.

Bone morphogenetic protein‐2 is a stronger inducer of osteogenesis within muscle tissue than heterodimeric bone morphogenetic protein‐2/6 and ‐2/7: Implications for expedited gene‐enhanced bone repair

“…Especially in an aging population, large bone defects and fracture non‐unions constitute major challenges to surgeons . Mills et al . reported that up to 9% of bone fractures lead to non‐unions.…”

“…reported that up to 9% of bone fractures lead to non‐unions. Because the treatment of a patient with a non‐union costs between EUR 8000 to 91 000, insufficient bone healing represents an enormous economical burden to the healthcare system . Moreover, the outcome of spinal fusion surgeries also depends on the body's capacity to heal bone.…”

“…Because the treatment of a patient with a non-union costs between EUR 8000 to 91 000, insufficient bone healing represents an enormous economical burden to the healthcare system. 3 Moreover, the outcome of spinal fusion surgeries also depends on the body's capacity to heal bone. The 22 000 revision spinal fusion procedures in the USA in 2009 added costs of up to $ 91 000 per patient to the healthcare bill.…”

Psoralen accelerates bone fracture healing by activating both osteoclasts and osteoblasts

“…Although the majority of fractures heal uneventfully, it takes several months for the bone to heal and it cannot bear weight before it is completely healed. Unfortunately, 5–10% of fractures result in either nonunion or delayed union (2, 3). Moreover, the annual cost of treatment of bone fractures is up to $21 billion in the United States (4).…”

Recent advances in gene‐enhanced bone tissue engineering

“…Bone has an intrinsic ability to regenerate but often fails to heal if there is a lack of mechanical stability or vascularization or if the bone defect is too large. Recent analyses of data from a large number of patients demonstrated that non‐unions occur in up to 9% of fractures . The treatment of a patient with a non‐union can cause substantial costs, ranging between €8000 and €91 000 .…”