Assessment of Compromised Fracture Healing

Bishop, Julius A.; Palanca, Ariel; Bellino, Michael J.; Lowenberg, David W.

doi:10.5435/jaaos-20-05-273

Cited by 266 publications

(185 citation statements)

References 38 publications

Supporting

Mentioning

168

Contrasting

Unclassified

Order By: Relevance

“…3 The risk of nonunion is related to the severity of injury resulting in fracture, 4 and many randomized clinical trials 5 have shown that variations in nonunion rates are associated with different surgical treatments. However, progression to nonunion is not fully explained by these factors alone.…”

mentioning

confidence: 99%

Epidemiology of Fracture Nonunion in 18 Human Bones

et al. 2016

View full text Add to dashboard Cite

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...

show abstract

mentioning

confidence: 99%

Epidemiology of Fracture Nonunion in 18 Human Bones

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Several studies have elucidated risk factors associated with a failure to achieve union after fracture. [1][2][3][4][5] Factors precluding healing can be grouped into those associated with mechanical instability or those associated with poor fracture biology. 1 An unstable fixation construct leads to potential shearing forces at the fracture site which limits both primary and secondary bone healing.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Factors precluding healing can be grouped into those associated with mechanical instability or those associated with poor fracture biology. 1 An unstable fixation construct leads to potential shearing forces at the fracture site which limits both primary and secondary bone healing. 6 Biologic factors are sometimes implicated and include complex fracture patterns, bony comminution, interfragmentary gap, bone loss, poor soft tissue coverage, and vascular deficiency.…”

Section: Introductionmentioning

confidence: 99%

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Taormina

Shulman

Karia

et al. 2014

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction: Elderly patients are at risk of fracture nonunion, given the potential setting of osteopenia, poorer fracture biology, and comorbid medical conditions. Risk factors predicting fracture nonunion may compromise the success of fracture nonunion surgery. The purpose of this study was to investigate the effect of patient age on clinical and functional outcome following long bone fracture nonunion surgery. Materials and Methods: A retrospective analysis of prospectively collected data identified 288 patients (aged 18-91) who were indicated for long bone nonunion surgery. Two-hundred and seventy-two patients satisfied study inclusion criteria and analyses were performed comparing elderly patients aged !65 years (n ¼ 48) with patients <65 years (n ¼ 224) for postoperative wound complications, Short Musculoskeletal Functional Assessment (SMFA) functional status, healing, and surgical revision. Regression analyses were performed to look for associations between age, smoking status, and history of previous nonunion surgery with healing and functional outcome. Twelve-month follow-up was obtained on 91.5% (249 of 272) of patients. Results: Despite demographic differences in the aged population, including a predominance of medical comorbidities (P < .01) and osteopenia (P ¼ .02), there was no statistical differences in the healing rate of elderly patients (95.8% vs 95.1%, P ¼ .6) or time to union (6.2 + 4.1 months vs. 7.2 + 6.6, P ¼ .3). Rates of postoperative wound complications and surgical revision did not statistically differ. Elderly patients reported similar levels of function up to 12 months after surgery. Regression analyses failed to show any significant association between age and final union or time to union. There was a strong positive association between smoking and history of previous nonunion surgery with time to union. Age was associated (positively) with 12-month SMFA activity score. Conclusions: Smoking and failure of previous surgical intervention were associated with nonunion surgery outcomes. Patient's age at the time of surgery was not associated with achieving union. Advanced age was generally not associated with poorer nonunion surgery outcomes.

show abstract

“…FDA (United States Food and Drug Administration)'ya göre, bir kırığa kaynamama denilebilmesi için yaralanmadan sonraki 9. ayda hala tam iyileşme olmaması ya da son üç aylık takiplerinde iyileşmede herhangi bir ilerlemenin olmaması gerekir. [50] Kemiğin ne kadarlık bir kısmının yaralandığı, kırığın şekli, bölgesi ve kırığa ek yaralanmalar, hastanın yaşı, ek hastalıkları, kullandığı ilaçlar, sigara alışkanlığı göz önünde bulundurularak, kaynamanın buna göre değerlendirilmesi gerekmektedir. [51] Kaynamama Tipleri a. Hipertrofik kaynamama: Kanlanmanın yeterli olduğu kırıklarda fragmanlar arasındaki fazla harekete bağlı belirgin kallus oluşumu, doku farklılaş-masında yetersizlikle karakterize kaynamamadır.…”

Section: B2 Eksternal Fiksatörlerunclassified

Kırık iyileşmesi

Tanrıkulu¹,

Gönen²

2017

TOTBID

View full text Add to dashboard Cite

patolojik kemik yapılarında görülür ve lamellar kemiğe göre daha fazla sayıda osteosit içeren, daha dayanıksız ve daha esnek bir yapıdadır.Kortikal kemik yapısının; Haversian kanallarla birbirine bağlanan osteonlardan oluştuğu görülür. Bu kanallar arteriol, venül, kapiller damarlar, sinirler ve lenfatik kanallar içerir. Osteonlar arasında birbirine fibriller ile bağlanan interstisiyel lameller vardır. Fibriller osteonun dış sınırın oluşturan sement çizgisine kadar uzanır. Kemiğin beslenmesi intraosseöz kan dolaşımı ile olur. Kortikal kemiğin yavaş bir döngüsü vardır, torsiyon ve bükülme kuvvetlerine karşı direnci kansellöz kemikten daha fazladır.

show abstract

Assessment of Compromised Fracture Healing

Cited by 266 publications

References 38 publications

Epidemiology of Fracture Nonunion in 18 Human Bones

Epidemiology of Fracture Nonunion in 18 Human Bones

Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery

Kırık iyileşmesi

Contact Info

Product

Resources

About