Delayed Union and Nonunion of Fractures

Cleveland, Kevin B.

doi:10.1016/b978-0-323-07243-4.00059-1

Cited by 16 publications

(22 citation statements)

References 330 publications

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“…Radiographic follow-up was used to determine union, defined as the presence of bridging callus in at least three of four cortices, which were evaluated on radiographs in two transverse levels 15 . Non-union was defined as non-radiographic changes to union or the absence of bridging callus of two or more cortices, which were evaluated on radiographs in two transverse levels, for at least 6 months after surgical or conservative treatment 16 - 17 .…”

Section: Methodsmentioning

confidence: 99%

“…Intramedullary nailing is the standard treatment for femoral shaft fracture in adults with non-OI. Its advantages include optimal mechanical stability, efficient load transfer, minimization of stress concentration, early mobilization of hip and knee, preservation of soft tissues, fracture hematoma, and periosteal blood supply 17 , 27 - 29 . Karadimas et al reviewed the complications of intramedullary nails in non-OI femoral fracture.…”

Section: Recommendations For Shaft Fracturesmentioning

confidence: 99%

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Incidence and treatment of adult femoral fractures with osteogenesis imperfecta: An analysis of a center of 72 patients in Taiwan

et al. 2021

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Background: Osteogenesis imperfecta (OI) is a rare disease characterized by increased bone fragility and susceptibility for fractures. Only few studies have compared the management for femoral fractures in children with OI. Nevertheless, no cohort studies have described the treatment for femoral fractures in adults with OI in Taiwan. This study aimed to investigate and compare the incidence of union and non-union femoral fractures and the best treatment options to avoid non-union fractures. Methods: We enrolled 72 patients with OI who were older than 18 years at MacKay Memorial Hospital between January 2010 and December 2018. Femoral fracture incidence, non-union rate, and treatment modality were analyzed. Results: Of 72 patients with OI, 11 patients had femoral fractures and 4 patients of them had >1 femoral fracture. The incidence for all types of femoral fractures was 651 fractures per 100,000 person-years annually. In 15 total fractures, 4 fractures resulted in non-union, and patients with type 4 OI mostly had shaft fractures. The best outcomes for non-union shaft fracture is achieved by surgical treatment. Conclusion: Adults with OI tended to develop femoral fractures and non-unions. Adults with type 4 OI were particularly at high risk for non-unions in shaft fractures with conservative treatment.

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Section: Methodsmentioning

confidence: 99%

Section: Recommendations For Shaft Fracturesmentioning

confidence: 99%

Incidence and treatment of adult femoral fractures with osteogenesis imperfecta: An analysis of a center of 72 patients in Taiwan

et al. 2021

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“…Union was defined as the presence of bridging callus in at least 3 of 4 cortices, evaluated on radiographs in two transverse levels [11]. Non-union was defined as non-radiographic changes to union or the absence of bridging callus of two or more cortices, evaluated on radiographs in two transverse levels, for at least 6 months after surgical or conservative treatment [12,13].…”

Section: Study Populationmentioning

confidence: 99%

“…Despite the fact that our study results in no definite consensus on the optimum surgical treatment for femoral shaft fractures, we favor intramedullary nailing. Intramedullary nailing is the standard treatment in case of a femoral shaft fracture in non-OI adults, which provides the advantages of optimal mechanical stability, efficient load transfer, minimization of stress concentration, early mobilization of hip and knee, preservation of soft tissues, fracture hematoma and periosteal blood supply [13,[22][23][24]. Karadimas et al conducted a literature review on complications using intramedullary nails in non-OI femoral fractures, reporting a nonunion rate of 1-14.1% [25].…”

Section: Recommendations For Shaft Fracturesmentioning

confidence: 99%

Incidence and treatment of femur fractures in adults with osteogenesis imperfecta: an analysis of an expert clinic of 216 patients

Goudriaan

Harsevoort

Leeuwen

et al. 2018

Eur J Trauma Emerg Surg

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Purpose Osteogenesis imperfecta (OI) is characterized by increased bone fragility and susceptibility for fractures. A few studies described and compared treatment modalities for femur fractures in children with OI. However, no cohort studies on adults with OI have been published. This study on adult OI patients aims to give insight into the incidence of femur fractures and non-unions and its best treatment options to avert non-union. Methods In this retrospective, descriptive study of the OI expert clinic in The Netherlands, all medical charts of patients 16 years or older were analyzed for femur fracture incidence, non-union rate and treatment modality. Results Of 216 OI patients, 34 patients suffered a femur fracture with 12 patients having more than 1 femur fracture. For all types of femur fractures, the incidence was 651 fractures per 100,000 person-years annually. In 49 total fractures, 10 fractures resulted in a non-union, mostly shaft fractures of type 4 OI patients. Surgically treated shaft fractures had the best outcomes for non-union. Conclusions OI adults were prone to developing femur fractures and non-unions. Especially type 4 OI adults, with conservatively treated shaft fractures, were at high risk for non-unions.

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“…Non-union of a fracture is defined as the cessation of all reparative processes of healing without bone-union ( 17 ). As previous data has demonstrated that the diagnosis of non-union fractures is based on clinical symptoms and physical findings, including pain at the fracture site and evidence of pathologic motion ( 18 ), there are seldom studies on the high-throughput screening and function identification of differential gene expression in fracture non-unions.…”

Section: Discussionmentioning

confidence: 99%

Screening of differentially expressed genes associated with non-union skeletal fractures and analysis with a DNA microarray

Zhang

Song

2014

Experimental and Therapeutic Medicine

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The purpose of this study was to identify the feature genes that are associated with non-union skeletal fractures using samples of normal union and non-union skeletal fracture microarray data. The gene expression profile GSE494 was downloaded from the Gene Expression Omnibus database and included 12 samples based on three different platforms (GPL92, GPL93 and GPL8300). Each of the platforms had four sets of expression data, two from normal union skeletal fracture samples and two from non-union skeletal fracture samples. The differentially expressed genes within the three platforms of expression data were identified using packages in R language and the differentially expressed genes common to the three platforms were selected. The selected common differentially expressed genes were further analyzed using bioinformatic methods. The software HitPredict was used to search interactions of the common differentially expressed genes and then FuncAssociate was used to conduct a functional analysis of the genes in the interaction network. Further, the associated pathways were identified using the software WebGestalt. Under the three different platforms, GPL92, GPL93 and GPL8300, the numbers of differentially expressed genes identified were 531, 418 and 914, respectively. The common gene CLU and its interacting genes were most significantly associated with the regulation of sterol transport and the osteoclast differentiation pathway. Upregulation of the gene CLU was identified by comparing data for normal union and non-union skeletal fracture samples. According to the function of CLU and its interacting genes, it was concluded that they inhibit the normal healing process following a fracture, and result in non-union skeletal fractures through the regulation of sterol transport and the pathways of differentiation in osteoclasts.

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Delayed Union and Nonunion of Fractures

Cited by 16 publications

References 330 publications

Incidence and treatment of adult femoral fractures with osteogenesis imperfecta: An analysis of a center of 72 patients in Taiwan

Incidence and treatment of adult femoral fractures with osteogenesis imperfecta: An analysis of a center of 72 patients in Taiwan

Incidence and treatment of femur fractures in adults with osteogenesis imperfecta: an analysis of an expert clinic of 216 patients

Screening of differentially expressed genes associated with non-union skeletal fractures and analysis with a DNA microarray

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